International Journal of Anesthesiology & Pain Medicine

Keywords

Prostate-Adenoma-PSA

Introduction

Benign prostatic hyperplasia is a condition that affects a significant proportion of men, particularly those over 60 years of age [1].

While the efficiency of medical treatments is indisputable, the risk of Benign prostatic hyperplasia -related surgery beyond the age of 50 is estimated to be between 20 and 30% [2]. Endoscopic Prostate Resection (EPR) and upper adenomectomy (UAP) are the gold standard procedures for complicated BPH or the ones refractory to medical treatment [3,4].

Upper adenomectomy is the primary method of surgery for benign prostatic hyperplasia. It remains the most common method used by urologists in underdeveloped countries [5]. It represented 1.1% of the operative activity of the general surgery department in Benin in 2015 [6]. But what is the margin of error between the preoperative diagnosis and the anatomopathological diagnosis? In order to answer this question, we conducted this study with the objective of determining the correlation between the digital rectal examination, the prostate volume, the PSA level and the anatomopathological results after prostatic adenomectomy by the high route indicated in front of a benign hypertrophy of the prostate diagnosed and operated on at the Saint Jean de Dieu Hospital of Tanguiéta.

Patients and Methods

This was a retrospective and descriptive study from January 1, 2017 to December 31, 2020 conducted in the general surgery department of the Tanguiéta Zone Hospital. All cases of prostatic hypertrophy labelled as benign and treated as such were included in the study, and for which the results of the digital rectal examination, prostatic ultrasound and anatomopathological examination were available in the medical record. The exclusion criteria were: Unavailability of pathology result, no information on PSA or DRE results, and cases operated endoscopically.

The parameters studied were: age, consultation time, length of hospitalization in surgery, ultrasound volume of the prostate, prostate specific antigen and histology of the surgical specimen.

Data entry and analysis were done on Epi-info data 7.2.2.6, Microsoft Excell 2013.

Mean, percentage and Chi-square test were used for interpretation of results.

Results

During the study period, 135 patients were managed for benign prostatic hypertrophy. 7 files were excluded for lack of information on PSA. This represents a study population of 128 cases. The mean age was 65.29 ± 7.84 years. The most represented age group was 61 to 70 years with a proportion of 54%. The mean time before consultation was 649.08 ± 760.21 days. Renal function was disturbed in 28.45% of our patients. The digital rectal examination in all patients was in favor of benign prostatic hypertrophy.

The mean PSA level was 27.64 ± 70.14 g. Patients with a PSA level greater than or equal to 4 ng/ml were the most representative (83%) compared to 17% for those with a PSA level lower than 4 ng/ml. The mean prostate volume was 89.91 ± 44.72 g. Patients with a volume between 59 and 105 g were the most represented (47%).

Most patients had a pathological finding of nodular hyperplasia. Of the 128 patients, only 14% had been diagnosed with adenocarcinoma of the prostate, 86% with benign prostatic hypertrophy.

Bivariate analysis between PSA level and prostate volume showed that the two variables were related. With prostate volume significantly influencing the PSA level (P=0.001) (Table I)The bi-variate analysis between PSA level and anatomopathological result had shown that the two variables were related (Table II). However, this relationship was weak (cramer coefficient=0.18). The multivariate analysis showed that only one variable influenced the PSA level (Table III) No correlation between age and PSA level was found (p-value greater than 5%) (Table IV)The same was true for prostate volume, where the patient's age had no influence on prostate volume (p-value greater than 5%) (Table V).

Table I: Distribution of patients by PSA levels according to prostate volume.

Table II: Distribution of patients by PSA level according to the anatomopathological result.

Table III: Multivariate analysis.

Table IV: Bivariate analysis between age and PSA level.

Table V: Analysis between age and volume.

The average length of hospitalization after Upper Aapproach Prostatic Adenomectomy was 11.03 ± 3.15 days.

Discussion

The average age in our study was 65.29 ± 7.84 years. The most represented age group was 61-70 years. These results are almost the same of the ones of Luhiriri ND et al [7].

Renal function was impaired in 28.45% of our patients. This percentage is much higher than that of Massandé Mouyendi J et al. which was 9% [8] and Bagayogo NA et al. which was 11.11% [9]. This could be due to the delay in consultation in our study environment which is rural compared to the other two studies carried out in urban areas, with a shorter delay in consultation than ours.

A strong correlation between prostate volume and PSA level was found in our study. These same findings had already been made by several authors [10,11,12]. Our study shows that patients with a PSA level lower than 4 ng/ml do not exceed 104 g of prostatic volume whereas those with a PSA level higher than 4 ng/ml see their prostatic volume reach a peak between 59 and 104 g and progressively decrease until a volume equal to 242 g. This clearly shows the close relationship between prostate volume and PSA level. Patients with a larger prostate volume being more likely to have a PSA level greater than or equal to 4.

No correlation between age and PSA level was found in our study. These results are consistent with those of some authors in the literature [13] but not all [11]. The same is true for the relationship between age and prostate volume where no significant relationship was found between these two variables. This is similar to the results of Berroukche A et al [14], but contrary to those of Bo M et al [13] who found a slight correlation (p <0.05). The study shows that there is a strong correlation between the PSA level and the anatomopathological nature of the prostate. But it also shows that patients with a PSA < 4 do not have adenocarcinoma, whereas those with a PSA > 4 have either adenocarcinoma or nodular hyperplasia. This is a known fact in the literature [11-13]. Our mean time of hospitalization was 11.03 ± 3.15 days. These results are in agreement with many authors in the literature [15,16].

The margin of error between the preoperative diagnosis and the anatomopathological diagnosis after prostatic adenomectomy was 14%, corresponding to the number of cases in which prostatic hypertrophy was falsely evoked.

Conclusion

After prostatic adenomectomy indicated for benign prostatic hypertrophy, 14% of cases were prostatic adenocarcinomas after anatomopathological examination. Only an increase in the volume of the prostate could explain an increase in the PSA level. The interpretation of the digital rectal examination, the ultrasound assessment of the prostate volume and the PSA level are effective diagnostic tools for benign prostatic hypertrophy in practice.

References

2. Bonnaure-Sorbier D (2020) Benign prostatic hypertrophy, a natural cellular aging process. Actualités pharmaceutiques 59:20-24
3. Reich O, Gratzke C, Bachmann A (2008) Urology section of the BavarianWorking Group for Quality Assurance. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10 654 patients. J Urol 180:246-9
4. Coulange C (2005) Current place of traditional surgery in France in the treatment of benign prostatic hyperplasia. E-Mem Natl Chir Academy 4: 8-11
5. Lahlaidi K, Ariane MM, Fontaine E (2014) Actualités sur la prise en charge de l?hyperplasie bénigne de la prostate. Quel adénome traiter et comment ? Rev Méd Int 35:189-95
6. Toré Sanni R, Mensah E, Hounnasso PP, Avakoudjo J, Allode A, et al. (2015) Postoperative complications of the suprapubic prostatectomy in a service of general surgery in Benin, About 124 cases. Méd Afr Noire 6202:83 – 89
7. Holtgrewe L (1995) Transurethral Prostatectomy. Urologic Clinics of North America 22: 357- 68
8. Luhiriri ND, Alumeti DM, Cirimwami P, Ahuka OL (2016) Diagnostic and surgical management of benign prostatic hyperplasia at PANZI Hospital / Democratic Republic of Congo. Uro’Andro 1:289-93
9. Massandé Mouyendi J, Mougougou A, Ndang Ngou Milama S, Adandé Menest E (2017) Morbidity and mortality post trans vesical open prostatectomy at the Libreville teaching hospital: a study of 68 patients. Uro’Andro 1:362-6
10. Bagayogo NA, Sine B, Faye M, Sarr A, Thiam A (2021) Giant benign prostatic hyperplasia (BPH): Clinical and therapeutic epidemiological aspects. J Afr Urol 27: 49-55
11. Bharti SV (2017) Correlation Between Serum Prostatic Specific Antigen and Prostatic Volume in Benign Prostatic Hyperplasia. J Nep Med Col 15:9-15
12. Okuja M, Ameda F, Dabanja H, Bongomin F, Bugeza S (2021) Relationship betweenserum prostate-specifc antigen andtransrectal prostate sonographic fndings inasymptomatic Ugandan males. Afr J Uro 27:2-9
13. Bagus IOWP, Hamid ARAH, Mochtar CA, Umbas R (2016) Relationship of age, prostate-specific antigen and prostate volume in Indonesian men with benign prostatic hyperplasia. Prostate Intl 4:1-6
14. Berroukche A, Bendahmane-Salmi M, Kandouci AB, (2013) Relationship between age and clinical and biological parameters. Sixtyseven cases of benign prostate hyperplasia in a western Algeria hospital. J Afr Cancer 5:1-6
15. Bo M, Ventura M, Marinello R, Capello S, Casetta G, et al. (2003) Relationship between Prostatic Specific Antigen (PSA) and volume of the prostate in the Benign Prostatic Hyperplasia in the elderly. Critical Reviews in Oncology/Hematology 47:207-11
16. Toré Sanni R, Mensah E, Hounnasso PP, Avakoudjo J, Allode A, et al. (2015) Postoperative complications of Trans bladder prostatic adenomectomy in a general surgery department in Benin: report of 124 cases. Med Afr Black 62: 83-89