Prospective Evaluation of Prostate Cancer Risk in Candidates for Inguinal Hernia Repair
Received 15 April 2009; received in revised form 18 May 2009; accepted 18 May 2009.
Background
Preperitoneal placement of mesh during herniorraphy has been shown to complicate future extirpative prostate surgery. We investigated the value of a prostate cancer screening program in patients considering laparoscopic inguinal herniorrhaphy to identify men at risk of prostate cancer.
Study Design
A prospective cohort study was conducted in men 30 years of age or older presenting with inguinal hernia. All patients were counseled on prostate cancer risk and the potential for herniorrhaphy with mesh placement to complicate future pelvic surgery. Serum prostate specific antigen (PSA) values were obtained, and patients determined to be at increased relative risk of prostate cancer were referred for urologic evaluation. Transrectal ultrasonography-guided biopsy was performed if clinically indicated, and operative data for patients undergoing prostate cancer treatment were retrospectively reviewed.
Results
There were 1,324 patients who presented for management of inguinal hernia; 814 of these (median age 60 years) consented to screening. Overall, 259 (32%) had an increased relative risk of prostate cancer based on PSA 1.0 to 2.49 ng/mL, and 152 (19%) had PSA ≥ 2.5 ng/mL. Transrectal ultrasonography-guided biopsy was performed in 86 patients. Prostate cancer was identified on initial or repeat biopsy in 31 patients (3.8%), including 1 patient (0.7%) younger than 50 years of age.
Conclusions
We found the incidence of concurrent prostate cancer with hernia to be low, but 51% of men had PSA values that suggested an increased relative risk of future development of prostate cancer. Men at increased risk of prostate cancer should be made aware of the impact that mesh might have on subsequent treatment options before mesh placement.
aGlickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
bDepartment of General Surgery, Cleveland Clinic, Cleveland, OH
cDepartment of Urology, University Hospitals Case Medical Center, Cleveland, OH
Correspondence address: J Stephen Jones, MD, Glickman Urological and Kidney Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Q10-1, Cleveland, OH 44195
Disclosure Information: J Stephen Jones received honoraria as lecturer and teacher for Pfizer, Endocare, and Abbott, and is a consultant for Cook. All other authors have nothing to disclose.
ABSTRACT