Prostatic cancer after prostatectomy for benign prstatic hyperplasia in Nigeria

Objectives: To establish the prevalence of ‘prostatic cancer after a previous prostatectomy for benign prostatic hyperplasia (BPH)’ and to find out if there are any differences in clinical presentation, histological characteristics and response to treatment, between this type ofcancer of prostate and that of prostatic cancer in patients with intact prostate.Design: A prospective study carried out between January 1989 and December 1998.Setting: University of Nigeria Teaching Hospital, Enugu and JAMA Urological Clinic in Enugu, Nigeria .Subjects: All patients presenting with histologically diagnosed carcinoma of the prostate during the study period.Interventions: Transperineal, transurethral and open prostatic biopsies. Hormonal manipulations, transurethral prostatic resections, and ureteroneocystostomies.Main outcome measures: Clinical presentation, histological characteristics of the tumour, and patient survival.Results: Eight hundred and forty seven new cases of cancer of prostate were seen during the study period and 39 of them had had prostatectomy for histologically diagnosed BPH in the past (tissues were cut by step sectioning technique), giving a prevalence rate of 4.6%. Ages of these 39 patients ranged from 64 to 89 years (mean 71.6 years), while that for the rest of carcinoma of prostate ranged from 56 to 87 (mean 70.4 years). Time interval between prostatectomy for BPH and presentation with prostatic cancer ranged from one to 10 years in 36 patients (mean 6.6 years) while the remaining three patients presented after 15, 20 and 22 years respectively. Histology in all the 847 patients showed adenocarcinoma. When the two groups were compared, there were no statistically significant differences in clinicalpresentation, histological grading, type of treatment and final outcome.Conclusion: Prostatic carcinoma after prostatectomy for BPH is not uncommon. It should be managed in the same line as those with cancer in intact prostate