A study to determine the prevalence of incidental prostate carcinoma in patients clincally diagnosed with benign prostate hyperplasia and treated by transvesical protatectomy at the University Teaching Hospital in Lusaka,Zambia

Abstract

At the University Teaching Hospital, Department of Surgery, Urology section, prostate carcinoma is number one cause of mortality among patients. All the cases of prostate carcinoma mortalities are patients who present to the hospital when their disease is advanced with evidence of metastasis. At this stage, the cure is no longer possible, and the treatment is only palliative. It is also known that prostate carcinoma at the early stage can be present in pre-existing benign prostate hypertrophy (BPH). When diagnosed at this stage (as incidental prostate carcinoma), the cure is possible by means of radical prostatectomy or radiotherapy. At the University Teaching Hospital, Department of Surgery, Urology section, BPH accounts for more than 50% of all elective cases. The objectives where to determine the prevalence of incidental prostate carcinoma in patients clinically diagnosed with BPH who underwent transvesical prostatectomy and to determine the association between patient’s baseline characteristics and incidental prostate carcinoma. This was a sixteen (16) months prospective cross section study. The study consisted of ninety one (91) patients who underwent transvesical prostatectomy for benign prostate hypertrophy (BPH). All patients with prostate carcinoma prior to surgery were excluded from this study. The enucleated prostate glands were taken for histopathological analysis at the laboratory of the University Teaching Hospital. A simple random sampling method was used to capture the study participants. A questionnaire was administered on the second postoperative day to capture demographic characteristics and clinical data. Collected data was entered in Microsoft Excel Version 2007 and then transferred to SPSS software version 20 for statistical analysis. This study showed Ninety one (91) patients underwent transvesical prostatectomy, six specimens representing 6.6% of the enucleated prostate glands were found to have incidental prostate carcinoma. Patients with carcinoma showed their age ranging from 67 to 81 years with the average age of 75 years. While the average weight of enucleated prostate gland for all patients in the study was 78.55 grams; the enucleated prostate glands of those with prostate carcinoma had an average weight 60.50 grams. Among the indications for prostatectomy two parameters were found more likely to be associated with incidental prostate carcinoma. These parameters were failure of medical treatment, and renal failure. However after statistical analysis, the difference v between the associations of incidental prostate carcinoma and patients baseline characteristics was not statistically significant. In conclusion this study has shown that 6.6% of the patients undergoing transvesical prostatectomy for benign prostate hyperplasia have incidental prostate carcinoma. All patients were 70 years old and above, with well differentiated prostate carcinoma, and with Gleason score of six. The rate of 6.6% of incidental prostate carcinoma as found in this study which is pre-PSA for practice sake, is in range of findings of incidental prostate carcinoma in studies conducted during the PSA era. This shows the safety of a well conducted clinical examination in differentiating benign prostate hyperplasia (BPH) from prostate carcinoma.