High Burden of Incidental and High-Grade Prostatic Carcinoma in Transurethral Resection of the Prostate (TURP) Specimens: A Retrospective Histopathological Analysis From Central India

TL;DR

This study found a high rate of incidental and aggressive prostate cancer in TURP specimens from Central India, emphasizing the need for thorough histopathological evaluation.

Contribution

The study highlights the high prevalence of high-grade prostate cancer in TURP specimens from a rural Indian setting.

Findings

17.90% of TURP specimens showed incidental prostatic adenocarcinoma.

53.8% of detected cancers were aggressive (Grade Group 3 or higher).

Younger men (<50 years) had the highest malignancy rate at 62.5%.

Abstract

Introduction: The histopathological evaluation of transurethral resection of the prostate (TURP) chips, primarily performed for benign prostatic hyperplasia (BPH), remains critical for the incidental detection of pre-malignant and malignant prostatic lesions in resource-limited settings lacking comprehensive screening. This study aimed to characterize the histopathological spectrum of prostatic pathology and the severity of incidentally detected cancer in a rural area of Central India.

Methods: This was a single-center, retrospective study analyzing 218 consecutive TURP chip specimens received between July 2024 and November 2025. Data, including histopathological diagnosis, age distribution, and International Society of Urological Pathology (ISUP) 2014 Grade Group (GG) for incidental carcinoma, were collected. The Pearson Chi-square test was used to assess the association between age and malignancy.

Results: Out of 218 specimens, 75.68% (n = 165) were benign, and 18.36% (n = 40) were malignant. The prevalence of incidental prostatic adenocarcinoma (IPCa) was high at 17.90% (39 cases). Crucially, 53.8% (n = 21) of these adenocarcinomas were classified as aggressive (Grade Group 3 or higher), indicating a substantial burden of intermediate-to-high-grade disease. A statistically significant association was found between age and the presence of malignancy (Chi-square = 12.06, df = 4, p = 0.017). The highest proportional malignancy rate (62.5%) was noted in the youngest age group (<50 years).

Conclusion: The exceptionally high prevalence of incidental carcinoma and the significant proportion of high-grade disease (GG ≥ 3) underscore the necessity of mandatory and thorough histopathological evaluation of all TURP specimens, irrespective of pre-operative clinical findings, especially considering the high malignancy rate in younger men (<50 years), to ensure timely diagnosis and aggressive management in this population.

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