Incidental adenocarcinoma of the prostate: The role of repeat transurethral resection in staging

Abstract

Accurate staging of patients with incidental prostatic adenocarcinoma (A₁ vs A₂) is crucial to the selection of appropriate treatment. To evaluate the potential sampling error in specimens obtained by transurethral resection, repeat resection was performed on 31 patients pathologically staged as A₁ (five or less chips with tumor). Second specimens showed no tumor in 22 (71 %), stage A₁ in six (20%), and stage A₂ in three (9%). The weight of tissue removed at reresection was greater in patients found to have more extensive involvement (P < 0.005). No patient with initial Gleason score 2, 3, or 4 had stage A₂ at reresection. Repeat resection is not routinely necessary, but may be helpful when the tumor is high grade but of minimal extent, in an anxious younger patient who may wish therapy if disease persists, or where some suspicion of an incomplete resection exists.