[Retropubic adenomectomy in patients with a high level of prostate-specific antigen after prostatic biopsy].

ABSTRACT

Results of examination and treatment were analysed for 58 patients after retropubic adenomectomy performed from February 2008 to June 2010. The examination protocol included assessment of a total score of the scales IPSS and QoL, parameters of uroflowmetry, total PSA, the size of the prostate, number of prostatic biopsies in a high PSA level. The removed adenomatous tissue was examined histologically. By a PSA level, all the patients were divided into 3 groups. Group 1 - 18 patients with a preoperative PSA level above 10 ng/ml, group 2 - 23 patients with a PSA level from 4 to 10 ng/ml, group 3 - 17 control patients with PSA under 4 ng/ml. Mean age of the examinees was 67.7 +/- 7, 68.7 +/- 7.7, 67.9 +/- 8.9 years (p>0.05), respectively. A mean PSA level was 20.9 (10.3-53), 6.6 (4.1-9.9) and 2.4 (1.3-3.9) ng/ml (p<0.01), respectively. A mean size of the prostate was larger in group 1 patients than in the controls 127.3 (82-185) cm3 versus 100.7 (81-134) cm3 (p<0.05). Median of the number of transrectal multifocal biopsies was 2 (1-7), 1 (1-2) and 0 in groupl, 2 and 3, respectively. Histological examination of the adenomatous tissue detected prostatic adenocarcinoma in 0, 1(4.3%) and 1(5.9%) patients, respectively, while chronic prostatitis at different stages was diagnosed in 6(33.3%), 7(30.3%) and 7(41.2%) patients, respectively. Thus, the above protocol of examination of patients with prostatic adenoma including measurement of a PSA level, conduction of finger rectal examination followed by prostatic biopsy (transrectal saturation procedure is preferable) provides performance of adenomectomy without a risk to miss a clinically significant prostatic cancer even in a PSA level above 10 ng/ml.