Incidental Prostate Cancer Despite Normal PSA and DRE: Evidence from a Libyan TURP Cohort

Background: Incidental prostate cancer (IPC) is occasionally diagnosed following transurethral resection of the prostate (TURP) performed for benign prostatic hyperplasia (BPH). Although men with normal preoperative prostate-specific antigen (PSA ≤ 4 ng/mL) levels and unremarkable digital rectal examination (DRE) findings are typically considered low-risk, the true incidence of IPC in this subgroup remains inadequately characterised. This raises concerns about the reliability of PSA and DRE as sole screening tools. Objectives: The primary objective of this study was to determine the incidence of IPC among patients undergoing TURP at a single centre in Tobruk, Libya, with normal preoperative PSA and DRE results. A secondary objective was to explore potential associations between IPC detection and patient characteristics, including age and PSA levels. Methods: A retrospective analysis was conducted on 81 patients who underwent TURP for symptomatic BPH at Tobruk Medical Center between January 2022 and January 2024. All patients had normal preoperative PSA levels (≤ 4 ng/mL), normal DRE findings, and no prior clinical suspicion or diagnosis of prostate cancer. TURP specimens were routinely subjected to histopathological examination to identify IPC. Statistical analyses were performed to assess differences between IPC-positive and IPC-negative groups. Results: IPC was identified in 7 of 81 patients, corresponding to an incidence of 8.6% (95% confidence interval: 3.6%–17.2%). Patients with IPC tended to be older and exhibited slightly higher PSA levels compared to those without IPC; however, these differences did not reach statistical significance. The limited number of IPC cases constrained the statistical power of the analysis, warranting cautious interpretation. Conclusion: An IPC incidence of 8.6% was observed among patients with normal preoperative PSA and DRE findings undergoing TURP. These findings underscore the potential limitations of relying solely on standard screening methods and highlight the value of routine histopathological evaluation of TURP specimens, even in presumed low-risk populations.