Should We Send TURP Histology for Pathological Examination?

Abstract

Transurethral resection of the prostate (TURP) has historically provided tissue for histological assessment as a by-product of surgery, but contemporary prostate cancer (PCa) pathways increasingly rely on risk stratification before surgery for benign prostatic obstruction. Although modern series suggest that incidental PCa detected in TURP specimens is relatively common, it is predominantly low grade and managed conservatively. Moreover, transition zone cancers, which are typically sampled by TURP, may show more favorable pathological features and recurrence outcomes than peripheral zone cancers, suggesting a lower risk of missing aggressive disease if routine TURP chip analysis is omitted. Routine processing is also resource intensive, may cause psychological harm, and is costly. These findings do not support routine histological examination of TURP chips in men with low preoperative suspicion of patient-important PCa and instead support evaluation of a risk-adapted strategy.

Patient summary

Transurethral resection of the prostate is an operation to remove prostate tissue blocking urine flow. Sometimes cancer is found unexpectedly in this tissue. Most such cancers are small, slow growing, and unlikely to cause harm. Avoiding routine tissue testing may reduce worry and unnecessary follow-up while still allowing patients at higher risk to undergo selective histological evaluation.