Journal of Cancer Therapy, 2012, 3, 256-262 http://dx.doi.org/10.4236/jct.2012.34036 Published Online August 2012 (http://www.SciRP.org/journal/jct) Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment? Adnan Simsir 1* , Bulent Akdogan 2 , Cag Cal 1 , Sumer Baltaci 3 , Haluk Ozen 2 1 Department of Urology, Ege University School of Medicine, Izmir, Turkey; 2 Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey; 3 Department of Urology, Ankara University School of Medicine, Ankara, Turkey. Email: * adnan.simsir@ege.edu.tr, blntakdogan@yahoo.com, cag.cal@ege.edu.tr, sbaltaci@hotmail.com, drhalukozen@gmail.com Received June 2 nd , 2012; revised July 10 th , 2012; accepted July 23 rd , 2012 ABSTRACT Objective: Prostate cancer is detected in pathology specimens in 3% - 16% of patients undergoing Benign Prostatic Hyperplasia (BPH) surgery. There is no consensus about the optimal treatment plan for these patients. In this study, T1a,b and T1c patients were compared oncologically and in terms of operative morbidity. Materials and Methods: This study included 54 patients (Group 1) undergoing RP based on the detection of incidental prostate cancer and 54 patients (Group 2) undergoing RP based on the diagnosis of carcinoma by biopsy in three different centers. The parameters that may affect the recurrence were investigated and compared between the two groups. Additionally, patient complaints after RP such as stress urinary incontinence, lower urinary tract symptoms and erectile dysfunction were evaluated according to questionnaires and were compared between the groups and within the group in which incidental carcinoma was identified. Data analysis was performed using SPSS version 15. Results: The mean age of the patients was 63.8 years (range 51 - 78 years) with a mean follow up of 60.4 months (range 12 - 82 months). There were statistical differences in age (p = 0.036), pre-RP PSA (p < 0.001) and pre-RP prostate volume (p < 0.001) between Group 1 and Group 2. Despite the absence of a statistically significant difference in PSM between the two groups (p = 0.09), ECE was more common in Group 2 patients (p = 0.014). None of the patients with T1a disease had biochemical recurrence which was observed in 9 patients (27.3%) with stage T1b disease (p = 0.007). There were significant differences in Gleason scores in BPH specimens and RP specimens, PSM, ECE and T stages between the two subgroups. The assessment of the morbidities that are likely to affect the quality of life by questionnaires revealed that there were no significant differences between Group 1 and Group 2 however significant differences were noted in the erection quality between the subgroups (p = 0.006). Conclusion: The course of the disease is determined by the stage of the disease (pT1a, pT1b) that indicates tumor burden in these patients. With regard to postoperative complications, the problems affecting the quality of life were not poorer in patients with T1a and T1b disease than that in patients with T1c disease, which is encouraging for radical surgery. Keywords: Radical Prostatectomy; PSA; Biochemical Recurrence; Erectile Dysfunction; Urinary İncontinence; Lower Urinary Tract Symptoms 1. Introduction The interventions performed for the treatment of Benign Prostatic Hyperplasia (BPH) remains to be the most com- mon surgical interventions around the world [1]. Even though the discovery of Prostate Specific Antigen (PSA) is a revolutionary development in the differential diagno- sis of BPH and carcinoma, incidental carcinoma is found in pathology specimens in 3% - 16% of patients undergo- ing BPH surgery [2-4]. There is no consensus on what type of treatment should be administered in these patients once diagnosed. While some researchers advocate aggressive treatment, others believe that follow-up would be more appropriate. Radical prostatectomy remains the most ef- fective therapy for the treatment of prostate cancer in pa- tients with a life expectancy of over 10 years [5]. Recent- ly, with increased patient awareness and attempts to in- crease the quality of life, the aim of cancer surgery has been not only to remove cancer but also to minimize the morbidity rate and to improve quality of life as much as possible. In this study, patients treated with RP based on the diagnosis of incidental prostate cancer (PCA) after BPH surgery and those who were treated with RP based * Corresponding author. Copyright © 2012 SciRes. JCT