[P-07] Clinicopathological evaluation of transurethral resection of prostate in Sri Lankan setting

Lalani De Silva1, Sinha De Silva2, Harshima Wijesinghe1, Gayani Ranaweera1, Priyani Amarathunga1, Niranthi Perera1 and Chandu De Silva1

  1. Department of Pathology, Faculty of Medicine, University of Colombo, Sri Lanka
  2. Postgraduate Institute of Medicine, University of Colombo, Sri Lanka

 

Background and Objectives: Transurethral resection of prostate (TURP) is the primary surgical treatment modality for lower urinary tract obstructions due to prostatomegaly. The objective was to describe the clinical and histopathological features of TURP specimens handled by a tertiary-care centre in Sri Lanka.

Materials and Methods: The sample included were all the TURP specimens received over 6 months to our centre. Clinicopathological characteristics were studied and analysed by descriptive statistics.

Results: One hundred and twelve TURP specimens were included. Age ranged from 50 – 90 years with a mean age of 68.3 years (SD = 8.2 years). The commonest clinical presentation was poor flow (49.1%, n = 55), followed by acute urinary retention (22.3%, n = 25), hesitancy (9.8%, n = 11), urgency (5.4%, n = 6) and haematuria (5.4%, n = 6). Average duration of clinical symptoms was 2.17 years (SD = 3.3 years). The majority had BPH (78.6%, n = 88). 25% (n = 22) of them had inflammatory changes. Twenty-four (21.4%) were malignant, of which 22 (91%) had acinar adenocarcinoma, two had combined acinar adenocarcinoma & ductal carcinoma and one had neuroendocrine differentiation. The most common Gleason pattern was Pattern-5 (41.6%), followed by Pattern-4 (37.5%) and Pattern-3 (20.8%). The commonest WHO/ISUP-grade group was 5 (62.5%), followed by 3 (12.5%), 2 (12.5%), 1 (8.3%) and 4 (4.2%) in a descending order. Tumour extent ranged from 1% - 95% and 54.2% had tumour extent more than 80%. Perineural invasion, vascular invasion and PIN were present in 41.7% (n=10), 8.3% (n=2) and 16.7% (n=4) respectively. Serum PSA level ranged from 1.07 – 1,100 ng/dL. Mean PSA value of BPH was 26.99 ng/dL (SD = 73.38 ng/dL) and of carcinoma was 135.45 ng/dL (SD = 69.42 ng/dL). PSA value was not a good marker to detect malignancy as analysed by ROC curve [AUC was 0.68 (95% CI = 0.49 – 0.87)] with p = 0.054).

Conclusion: The majority of the TURP was having BPH. Though rare, most of the malignancies detected were of high grade and had high tumour burden.