OBJECTIVETo assess the application value of diagnostic transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) patients with persistently abnormal serum PSA levels.

METHODSWe performed TURP for 71 BPH patients with the PSA level > 4 microg/L, and analyzed the Gleason scores and prognosis of the cases pathologically confirmed as prostate cancer (PCa). We conducted follow-up visits to all the patients, obtained the PSA levels and International Prostate Symptom scores (IPSS) at 6 and 12 months after TURP, analyzed their changes and assessed the value of TURP in the diagnosis and treatment of BPH with serum PSA abnormality.

RESULTSAmong the 40 patients with negative prostate biopsy and persistent serum PSA abnormality, 2 cases were diagnosed as Gleason score 6 prostatic adenocarcinoma by TURP biopsy, and 1 case as Gleason score 6 PCa by repeated biopsy. All the 3 patients underwent radical prostatectomies and were well recovered during the follow-up visits. Of the 31 patients who had refused biopsy, 9 cases were confirmed by postoperative pathology as Gleason score 7 -9 PCa, 1 treated by radical prostatectomy and the other 8 by endocrine therapy. Another 59 cases were pathologically diagnosed as BPH, of which, the serum PSA level was restored to normal in 56 and significantly reduced in the other 3, and IPSS was remarkably increased in 53 and improved in the other 6 following urethral soundings.

CONCLUSIONDiagnostic TURP can increase the early diagnosis rate of PCa, improve lower urinary tract symptoms (LUTS) and help to normalize the serum PSA level. Therefore, it can be chosen for those with persistent serum PSA abnormality, LUTS and negative prostate biopsy.