Department of Urology, Seoul National University Hospital, Seoul, South Korea.
Department of Urology, SMG-SNU Boramae Medical Center, Seoul, South Korea.
PLoS One. 2023 Feb 2;18(2):e0278931. doi: 10.1371/journal.pone.0278931. eCollection 2023.
There is no consensus on the management plan for incidental prostate cancer (IPCa) after holmium laser enucleation of the prostate (HoLEP). This study aims to investigate the natural course of this disease and suggest appropriate treatment in real clinical practice.
The medical records of a prospective cohort of patients with LUTS/BPH who underwent HoLEP between July 2008 and December 2020 at Seoul National University Hospital were retrospectively reviewed. Patients who underwent HoLEP for palliative purpose of prostate cancer control were excluded. The natural history of IPCa was assessed by the clinician in a descriptive manner for each treatment option.
Among 2630 patients, 141 (5.4%) were diagnosed with IPCa after HoLEP. Pathologic T stage and magnetic resonance imaging results were highly associated with the physician's primary treatment decision-making for IPCa. Active surveillance (AS) was performed in 80% of patients, of whom 90% underwent follow-up without intervention, while the remaining 10% underwent deferred active treatment with a median follow-up of 46.3 months due to International Society of Urological Pathology grade group upgrading or increasing core involvement percentage. Meanwhile, 20% of patients underwent immediate active treatment. With a median follow-up period of 88.3 months after treatment, only one of 25 patients had biochemical recurrence.
The incidence of IPCa after HoLEP was 5.4%, and among these, approximately 20% proceeded with immediate definitive therapy and an additional 6% ultimately received definitive therapy within a median of 4 years of AS but showed excellent oncological outcomes.
对于经钬激光前列腺剜除术（HoLEP）后偶然发现的前列腺癌（IPCa），目前尚无共识的管理方案。本研究旨在探讨该病的自然病程，并在实际临床实践中提出合适的治疗建议。
回顾性分析 2008 年 7 月至 2020 年 12 月期间在首尔国立大学医院接受 HoLEP 治疗的以 LUTS/BPH 为主要症状的患者的前瞻性队列研究的病历资料。排除因前列腺癌控制而行 HoLEP 姑息性治疗的患者。根据临床医生的描述，对每种治疗选择的 IPCa 自然史进行评估。
在 2630 例患者中，有 141 例（5.4%）在 HoLEP 后被诊断为 IPCa。病理 T 分期和磁共振成像结果与医生对 IPCa 的主要治疗决策高度相关。80%的患者接受了主动监测（AS），其中 90%的患者未进行干预，仅 10%的患者由于国际泌尿病理学会（ISUP）分级组升级或核心受累百分比增加而接受了延迟的主动治疗，中位随访时间为 46.3 个月。同时，20%的患者接受了即时主动治疗。在治疗后中位随访 88.3 个月后，仅 25 例中有 1 例出现生化复发。
HoLEP 后 IPCa 的发生率为 5.4%，其中约 20%的患者立即接受了确定性治疗，另外 6%的患者在 AS 中位 4 年内最终接受了确定性治疗，但肿瘤学结果良好。
