QUANTITATION OF POTENTIALLY UNDIAGNOSED INCIDENTAL CARCINOMA OF THE PROSTATE IN PATIENTS TREATED NONSURGICALLY FOR BENIGN PROSTATIC HYPERPLASIA

Prostatectomy is the standard treatment for benign prostatic hyperplasia (BPH) and non-surgical treatment of prostatism would reduce the detection of Stage A prostate cancer. We wished to identify the number of potentially undiagnosed cancers resulting if non-surgical therapy were used to treat a presenting complaint of BPH. We also sought to identify the age group which would most clearly benefit from treatment of Stage A prostate cancer. Our series of transurethral prostatectomy specimens showed 92/996 patients (9.2%) positive for incidental carcinoma; 26/92 patients (28%) received further treatment and 25 of the 26 patients had Stage A2 disease. After evaluating life-tables and survival data on untreated A2 disease, the population aged less than or equal to 72 years had a relative benefit of treatment ratio > 1.0, i.e. had a greater likelihood of dying from prostate cancer than from natural causes; 17/616 (2.8%) of the population aged < 72 years had their A2 disease treated and would have potentially been denied early cancer treatment if non-surgical management of BPH had been employed. The above figures assume 100% non-surgical treatment of BPH and no screening for prostate cancer pre-treatment. Stage A2 patients in this study demonstrated no significant difference in cause-specific survival rates between treated and untreated study groups (both 0%) or between treated study patients and untreated historical patients. Treated A2 patients demonstrated a significantly lower 5-year progression rate (0 vs 32%) relative to untreated patients reported in the literature, and a trend toward a significantly lower progression rate (0 vs 25%) relative to untreated study patients.