Azhar Ali Shah, Khush Muhammad Sohu, Immamuddin Balouch, Ghulam Hyder Rind.
Frequency of malignancy in clinically benign open transvesical prostatectomy- a study of 100 cases.
Pak J Med Res Jan ;51(4):114-6.

Background: Enlargement of prostate can be benign and malignant. Though differentiation between the two can be made on clinical grounds and surgery but still some cases can be missed if not subjected to histopathology. Objectives: To find out the frequency of malignancy in patients operated for clinically benign open transvesical prostatectomy. Study type settings and duration: It was a prospective observational study conducted in the Department of surgery (Surgical Unit-I), Ghulam Muhammad Mahar Medical College and Hospital, Sukkur from January 2011 to December 2011. Patients and Methods: Patients presented with the history of prostatic symptoms were evaluated in surgical out-patient’s department using digital rectal examination and ultrasound. The findings were recorded in a proforma and those having enlarged prostate weighing above 40gm underwent prostate specific antigen testing. Patients having no malignant findings on history, digital rectal examination and whose prostate specific antigen levels were below 10 ng/dl underwent open transvesical prostatectomy and all specimens were sent for histopathology. Those with suspicion of malignancy either on history or digital rectal examination or high prostate specific antigen were excluded from the study, also the glands below 40 gm in volume were excluded and referred for transurethral resection. All specimens were sent for hisopathology. Results: Out of 100 cases, 41 were between 56 to 65 years of age. The mean age was 58 years. Acute urinary retention requiring catheterization was seen in 36 cases while 18 patients had symptoms suggestive of inguinal hernia but on examination had enlarged prostate. Prostate specific antigen was done in 07 patients with suspicion of malignancy but its value was below 10 ng/dl therefore they were included in the study. On ultrasound the gland volume ranged from 40 to 85 gm and residual post-voidal urinary volume ranged from 100 to 450ml. On histology 06 patients were found to have adenocarcinoma of prostate including 01 patient in whom mucosa of the gland was fixed but as the prostate specific antigen was below 10 ng/dl so the patient was kept in study group. Gleason score ranged from 4 to 9. Conclusions: Direct rectal examination is not a reliable test to detect early malignant changes in prostate and all specimens should be subjected to histopathology. Policy message: Histopathology of all operated and biopsied materials should be done to complete diagnosis.

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