Coman R, Anract J, Pinar U, Sibony M, Peyromaure M, Delongchamps Barry
Urology Department, Cochin Hospital, Paris, France.
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Int Urol Nephrol. 2022 Jul;54(7):1485-1489. doi: 10.1007/s11255-022-03220-6. Epub 2022 May 10.
After most surgical management of benign prostatic hyperplasia (BPH), the resected tissue undergoes a histological examination. This examination is performed for the risk of finding an incidental prostate cancer (iPCa). The improvement of prostate cancer detection in the past few years decreased the global iPCa rate. This raises the question of the real benefit for all patients of a systematic histological analysis. The aim of our study was to evaluate the iPCa detection rate on a large contemporary cohort of patients treated for BPH, and to define predictive factors of iPCa detection.
We retrospectively analyzed the medical charts of all consecutive patients who underwent surgical treatment for BPH in our academic center from 2012 to 2018. Patients with prostate cancer diagnosed before surgery were not included. All the resected tissue underwent standard histopathological examination. iPCa was defined by any grade or stage of prostate cancer identified on the resected tissue by the histological examination. The following variables were analyzed using an uni- and multi-variable logistic regression as potential risk factors of iPCa: age, total PSA, PSA density (PSAd), prostate volume, technique used, weight of resected tissue and use of 5ARI medication.
1045 patients were included in the study. Of them, 439 (42.0%), 206 (19.7%) and 400 (38.3%) underwent HoLEP, OP and TURP, respectively. iPCa was diagnosed in 94 (9.0%) of the 1045. Among them 15 (1.4%) were clinically significant (ISUP score ≥ 2). The multivariable logistic regression analysis identified age (p = 0.03) and PSA density (p < 0.001) as independent predictive factors for the detection of iPCa. Using the median of age and PSAd, we identified a population with 0% of iPCa in our cohort (age < 70 year-old and PSAd < 0.05 ng/mL/mL).
The global iPCa rate was 9% in this contemporary large cohort of patients who underwent surgical treatment for BPH, with 1.4% of clinically significant cancer. Age and PSAd were independent predictive factors to find iPCa. Patients younger than 70 with a PSAd < 0.05 ng/mL/mL had 0% of iPCA in our cohort. In this specific population, we could probably avoid a systematical histological examination of the resected tissue.
在大多数良性前列腺增生（BPH）手术治疗后，切除的组织会进行组织学检查。进行该检查是为了发现偶发前列腺癌（iPCa）的风险。过去几年中前列腺癌检测的改善降低了全球iPCa发生率。这就引发了对于所有患者进行系统组织学分析的实际益处的质疑。我们研究的目的是评估在接受BPH治疗的大量当代患者队列中iPCa的检出率，并确定iPCa检测的预测因素。
我们回顾性分析了2012年至2018年在我们学术中心接受BPH手术治疗的所有连续患者的病历。术前诊断为前列腺癌的患者不包括在内。所有切除的组织均进行标准组织病理学检查。iPCa由组织学检查在切除组织中发现的任何前列腺癌分级或分期定义。使用单变量和多变量逻辑回归分析以下变量作为iPCa的潜在危险因素：年龄、总前列腺特异抗原（PSA）、PSA密度（PSAd）、前列腺体积、使用的技术、切除组织的重量以及5α还原酶抑制剂（5ARI）药物的使用情况。
1045例患者纳入研究。其中，分别有439例（42.0%）、206例（19.7%）和400例（38.3%）接受了经尿道钬激光前列腺剜除术（HoLEP）、开放性前列腺切除术（OP）和经尿道前列腺电切术（TURP）。1045例中有94例（9.0%）诊断为iPCa。其中15例（1.4%）具有临床意义（国际泌尿病理学会（ISUP）评分≥2）。多变量逻辑回归分析确定年龄（p = 0.03）和PSA密度（p < 0.001）为iPCa检测的独立预测因素。使用年龄和PSAd的中位数，我们在队列中确定了一个iPCa发生率为0%的人群（年龄<70岁且PSAd<0.05 ng/mL/mL）。
在这个接受BPH手术治疗的当代大型患者队列中，总体iPCa发生率为9%，其中具有临床意义的癌症占1.4%。年龄和PSAd是发现iPCa的独立预测因素。在我们的队列中，年龄小于70岁且PSAd<0.05 ng/mL/mL的患者iPCa发生率为0%。在这个特定人群中，我们可能可以避免对切除组织进行系统的组织学检查。
