Elkoushy Mohamed A, Elshal Ahmed M, Elhilali Mostafa M
Division of Urology, Department of Surgery, McGill University Health Center, Montreal, QC, Canada; Department of Urology, Suez Canal University, Ismailia, Egypt.
Division of Urology, Department of Surgery, McGill University Health Center, Montreal, QC, Canada; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology. 2015 Sep;86(3):552-7. doi: 10.1016/j.urology.2015.06.002. Epub 2015 Jun 11.
To determine the prevalence and predictors of incidental prostate cancer (IPCa) after Holmium laser enucleation of the prostate (HoLEP) and to assess its functional and oncological outcomes.
A prospectively maintained database was reviewed for cases with IPCa at the time of HoLEP. Patients with preoperative PCa were excluded. Patients were divided into two groups based on the presence (group I [GI]) or absence of cancer (group II [GII]) in histopathology. Univariate and multivariate logistic regression analyses were performed.
Of 1242 patients, 70 (5.64%) were identified to have IPCa. Prostate size was comparable between both groups. GI patients had significantly higher preoperative prostate-specific antigen (PSA) and total PSA density (tPSAD) compared to cancer-free patients. T1a and T1b adenocarcinomas were detected in 54 (77.1%) and 16 (22.9%) patients, respectively. After a median follow-up of 48 (1-171) months, both groups were comparable in all functional outcomes but the quality of life was significantly better in GII. Patients' age and preoperative tPSAD independently predicted IPCa after HoLEP. A tPSAD cutoff value of 0.092 has a sensitivity and specificity of 0.83 and 0.67, respectively. Seven patients (11.7%) needed adjuvant therapy while other GI patients opted for active surveillance. The Kaplan-Meier analysis demonstrated an overall survival of 72.8% at 5 years and 63.5% at 10 years for patients with PCa.
PCa is not uncommonly identified after HoLEP, even in those with negative preoperative biopsies. In older patients, total PSAD could be a predictor using a cutoff <0.1. After HoLEP, active surveillance for low-grade PCa carries good functional and oncological outcomes.
确定钬激光前列腺剜除术（HoLEP）后偶发前列腺癌（IPCa）的患病率及预测因素，并评估其功能和肿瘤学结局。
回顾前瞻性维护的数据库中HoLEP时患有IPCa的病例。排除术前患有前列腺癌（PCa）的患者。根据组织病理学检查中是否存在癌症（I组[GI]）或不存在癌症（II组[GII]）将患者分为两组。进行单因素和多因素逻辑回归分析。
在1242例患者中，70例（5.64%）被确定患有IPCa。两组之间前列腺大小相当。与无癌患者相比，GI组患者术前前列腺特异性抗原（PSA）和总PSA密度（tPSAD）显著更高。分别在54例（77.1%）和16例（22.9%）患者中检测到T1a和T1b腺癌。中位随访48（1 - 171）个月后，两组在所有功能结局方面相当，但GII组的生活质量明显更好。患者年龄和术前tPSAD独立预测HoLEP后IPCa。tPSAD临界值为0.092时，敏感性和特异性分别为0.83和0.67。7例患者（11.7%）需要辅助治疗，而其他GI组患者选择主动监测。Kaplan-Meier分析显示，PCa患者5年总生存率为72.8%，10年为63.5%。
即使在术前活检阴性的患者中，HoLEP后也不罕见地发现PCa。在老年患者中，总PSAD临界值<0.1时可作为预测指标。HoLEP后，对低级别PCa进行主动监测具有良好的功能和肿瘤学结局。
