Insurgence of lethal prostate cancer after retropubic prostatectomy (rp) for benign prostatic hyperplasia (bph)

H. Jallous, C. Marandola, P. Marandola

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Abstract

The insurgence of prostatic carcinoma after surgical therapy for benign lesions of the prostate was described by Hunt for the first time in 1929. Approximatively, 2% of patients treated with prostatectomy for BPH, develop a late and slow progressing cancer. Prostate cancer caracterized by an early and rapid progression, has not been described in the literature. We therefore present our experience on this type of cancer. Over the last 6 years we have treated 296 patients, aged 49-84 with RP for bladder outlet obstruction secondary to BPH diagnosed on the basis of: medical history, clinical symptoms, digital rectal examination, transrectal ultrasonography, nrodynamic tests and PSA serie level. Only 203 patients with yearly follow-up for 5 years were reviewed. 193 patients (95%) were without any symptom. 10 patients (5%) developed cancer. From these, 7 developed a late and slow progressing cancer, the other 3 developed cancer in the first year of the follow-up and died within 6 months; Our interest is focused on these 3 cases in wich the cancer had developed 6-12 months after RP. They presented with a massive tumor at the rectal exploration and spread bone metastasis. In 1 case there was an invasion of the sacral spinal cord. In all of them, combined therapy with hormone, radio- and chemiotherapy was not effective. Cancer was revealed by PSA elevation, bone pain and disuria. The revision of the postoperative histological specimens of the whole prostate did not reveal any malignancy. This, study confirm that the risk of progression and death from prostate cancer is not significant after RP for BPH but suggest that we must take into consideration the fact that highly malignant cancers after RP exist. Up today, we are not able yet to give a satisfactory explanation for a such aggressive phenomenon. It is well known that: 1) prostate capsula or residual BPH tissue can originate a cancer and 2) progression of a simultaneous but undetectable cancer can occur. In all oui 3 cases it is possibile to postulate an independent capsulai origine of the cancer, which certainly requires further studies and research. At this stage, the only possibile conclusion is to reccomend a yearly follow-up in all patients treated with any type of prostatectomy for BPH and for at least 5 years. The prevention of prostate cancer doesn't end with subcapsular prostatectomy or transurethral resection for BPH.

Original languageEnglish
Pages (from-to)227
Number of pages1
JournalBritish Journal of Urology
Volume80
Issue numberSUPPL. 2
Publication statusPublished - 1997

ASJC Scopus subject areas

  • Urology

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