Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Urology, Sheba Medical Center, Ramat-Gan, Israel. Affiliated with Tel Aviv University, Tel Aviv, Israel.
Can J Urol. 2021 Dec;28(6):10900-10906.
The purpose of this study was to describe the current incidence, risk factors, and management of incidental diagnosis of prostate cancer (iPCa) among patients who underwent holmium laser enucleation of prostate (HoLEP) and have no history of prostate cancer.
We conducted a retrospective review of all patients who underwent HoLEP in our institution between 2013-2020. All patients were offered a PSA screening according to the latest guidelines. We gathered demographic data, perioperative information, and pathologic evaluation. For patients diagnosed with iPCa, we gathered work up, management, and oncologic outcome. We then conducted a univariate and multivariate analysis to find predictive factors for the diagnosis of incidental cancer.
The cohort included 777 patients, among them 55 (7.1%) patients with iPCa. The median age of the entire cohort was 71 years, median PSA was 3.9 mg/dL, and median prostate volume of 96 mL. Of those with iPCa, 34 (61.8%) patients had grade-group (GG) 1. Larger prostate size was found to be protective against iPCa, with a 13% risk reduction for every increment of 10 mL in prostate size. For prostates smaller than 100 mL, iPCa rate was 12.6%. Older age and smaller prostate volume were found to predict GG2-and-above iPCa.
iPCa at HoLEP is rare, with clinically significant cancer being even rarer. Smaller preoperative prostate was found to be a predictive factor for iPCa. Our results provide an insight into the current risk and predictive factors to iPCa and can be used to guide surgeons and patients in the preoperative recommendations and informed consent process.
本研究旨在描述无前列腺癌病史的患者行钬激光前列腺剜除术（HoLEP）后偶然诊断为前列腺癌（iPCa）的当前发病率、危险因素和处理方法。
我们对 2013 年至 2020 年间在我院行 HoLEP 的所有患者进行了回顾性研究。所有患者均按照最新指南接受了 PSA 筛查。我们收集了人口统计学数据、围手术期信息和病理评估。对于诊断为 iPCa 的患者，我们收集了工作进展、管理和肿瘤学结果。然后，我们进行了单变量和多变量分析，以确定偶然癌诊断的预测因素。
该队列包括 777 名患者，其中 55 名（7.1%）患者为 iPCa。整个队列的中位年龄为 71 岁，中位 PSA 为 3.9mg/dL，前列腺体积为 96mL。在 iPCa 患者中，34 名（61.8%）患者为 GG1。前列腺体积越大，iPCa 的风险越低，前列腺体积每增加 10mL，风险降低 13%。前列腺体积小于 100mL 的患者，iPCa 发生率为 12.6%。年龄较大和前列腺体积较小与 GG2 及以上 iPCa 相关。
HoLEP 术后 iPCa 罕见，临床显著癌症更为罕见。术前前列腺较小是 iPCa 的预测因素。我们的研究结果为了解当前 iPCa 的风险和预测因素提供了线索，并可用于指导外科医生和患者进行术前建议和知情同意过程。
