Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Rome, 00128, Italy.
World J Urol. 2024 Aug 14;42(1):485. doi: 10.1007/s00345-024-05171-2.
Despite advancements in prostate multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB), the management of incidental prostate cancer (IPCa) after surgery for benign prostatic obstruction (BPO) remains unclear. The aim of this retrospective study is to determine the prevalence of IPCa in our cohort and identify potential predictors for its occurrence.
We enrolled patients underwent TURP or simple prostatectomy for BPO at our high-volume center between January 2020-December 2022. Data on age, pre-operative total PSA (tPSA) and PSA density (PSAd) levels, prostate volume, previous MRI, biopsies, specimen weight, rates of positive tissue slices, ISUP score and three-month tPSA were collected.
Of 454 patients with negative digital rectal examination who underwent BPO surgery, 74 patients (16.3%) were found to have IPCa. Of these, 33 patients (44.6%) had undergone previous mpMRI. Among the patients who had mpMRI, 23 had negative mpMRI results for suspected prostate cancer, while 10 had positive mpMRI findings (PIRADS ≥ 3) but no evidence of tumor upon FB. KW analysis indicates that PSAd was statistically associated with higher ISUP score, while at univariable regression analysis negative mpMRI (p = 0.03) was the only potential predictor for IPCa.
Among the ISUP groups, PSAd showed a correlation with the tumor, while negative mpMRI was protective against clinically significant PCa. In the era of mpMRI and FB, the IPCa rates found at our center is higher than reported in existing literature and if it were confirmed with further studies, maybe there is a need for expansion in urology guidelines.
尽管前列腺多参数磁共振成像（mpMRI）和融合活检（FB）技术有所进步，但对于良性前列腺梗阻（BPO）手术后偶然发现的前列腺癌（IPCa）的管理仍不清楚。本回顾性研究旨在确定我们队列中 IPCa 的患病率，并确定其发生的潜在预测因素。
我们招募了 2020 年 1 月至 2022 年 12 月在我们高容量中心接受 TURP 或单纯前列腺切除术治疗 BPO 的患者。收集的数据包括年龄、术前总 PSA（tPSA）和 PSA 密度（PSAd）水平、前列腺体积、既往 MRI、活检、标本重量、阳性组织切片率、ISUP 评分和三个月 tPSA。
在 454 例经直肠指检阴性的 BPO 手术患者中，有 74 例（16.3%）被发现患有 IPCa。其中，33 例（44.6%）患者曾接受过 mpMRI。在接受 mpMRI 的患者中，23 例 mpMRI 结果为疑似前列腺癌阴性，10 例 mpMRI 结果为阳性（PIRADS≥3）但 FB 未见肿瘤。KW 分析表明，PSAd 与更高的 ISUP 评分呈统计学相关，而在单变量回归分析中，阴性 mpMRI（p=0.03）是 IPCa 的唯一潜在预测因素。
在 ISUP 组中，PSAd 与肿瘤相关，而阴性 mpMRI 可预防临床显著的 PCa。在 mpMRI 和 FB 时代，我们中心发现的 IPCa 发生率高于现有文献报道，如果进一步研究证实，也许需要扩大泌尿科指南。
