Deparment of Urology, Onze-Lieve-Vrouw Ziekenhuis Aalst, Aalst, Belgium.
ORSI Acadamy, Melle, Belgium.
World J Urol. 2021 Jul;39(7):2621-2626. doi: 10.1007/s00345-020-03444-0. Epub 2020 Sep 30.
After Endoscopic Enucleation of the Prostate (EEP) for benign prostatic obstruction (BPO), men remain at risk for prostate cancer (PCa). Significant PSA changes occur after enucleation, which interfere with later screening for PCa. It remains unclear which patients need further diagnostic investigations for PCa after EEP. The goal of this study was to identify an independent predictor for PCa diagnosis after Holmium Laser Enucleation of the Prostate (HoLEP) in patients whose HoLEP resection specimen did not show PCa.
Data of 773 patients who underwent HoLEP for BPO between 2010 and 2018 in a referral center were analyzed. Exclusion criteria were PCa detection in the HoLEP specimen or absence of post-operative PSA values. Patients were divided in a PCa group and Control group depending on whether or not PCa was detected during follow-up after HoLEP. The predictive value for future diagnosis of PCa of different forms of PSA-change after HoLEP was analyzed by multivariate Cox regression and ROC analysis.
Overall, 24 (4.2%) patients developed PCa after HoLEP. At 5 year follow-up, the PCa-free survival rate was 85%. First post-operative PSA was an independent predictor of PCa diagnosis after HoLEP (HR 1.106, 95% CI 1.074-1.139, p < 0.001, ROC AUC 0.903) with an optimal cut-off value of 1.73 ng/ml (sensitivity 83.3%, specificity 82.3%).
For patients who underwent HoLEP for BPO, post-operative PSA after HoLEP is an independent predictor for future PCa diagnosis. When PSA is > 1.73 ng/ml within the first year after HoLEP, rigorous follow-up and diagnostic investigations for PCa are indicated.
经内镜前列腺切除术（EEP）治疗良性前列腺梗阻（BPO）后，患者仍有前列腺癌（PCa）的风险。前列腺切除术后 PSA 显著变化，这会干扰 PCa 的后续筛查。目前仍不清楚 EEP 后哪些患者需要进一步进行 PCa 诊断性检查。本研究的目的是在经钬激光前列腺剜除术（HoLEP）治疗的患者中，确定那些 HoLEP 切除标本未发现 PCa 但术后 PSA 变化的患者中发生 PCa 的独立预测因子。
分析了 2010 年至 2018 年期间在一家转诊中心接受 HoLEP 治疗 BPO 的 773 例患者的数据。排除标准为 HoLEP 标本中发现 PCa 或术后 PSA 值缺失。根据 HoLEP 后随访期间是否检测到 PCa，将患者分为 PCa 组和对照组。通过多变量 Cox 回归和 ROC 分析，分析不同形式的 HoLEP 后 PSA 变化对 PCa 未来诊断的预测价值。
总体而言，24 例（4.2%）患者在 HoLEP 后发生 PCa。在 5 年随访时，PCa 无复发生存率为 85%。首次术后 PSA 是 HoLEP 后 PCa 诊断的独立预测因子（HR 1.106，95%CI 1.074-1.139，p<0.001，ROC AUC 0.903），最佳截断值为 1.73ng/ml（敏感性 83.3%，特异性 82.3%）。
对于接受 HoLEP 治疗 BPO 的患者，HoLEP 后 PSA 是未来 PCa 诊断的独立预测因子。当 HoLEP 后 1 年内 PSA>1.73ng/ml 时，需要进行严格的 PCa 随访和诊断性检查。
