Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA.
Department of Urology, Ohio State University College of Medicine, Columbus, Ohio, USA.
Prostate. 2024 Dec;84(16):1427-1433. doi: 10.1002/pros.24781. Epub 2024 Aug 18.
To evaluate contemporary preoperative risk factors and subsequent postoperative management of incidental prostate cancer (iPCa) and incidental clinically significant prostate cancer (icsPCa, Grade Group [GG] ≥ 2 PCa).
A retrospective cohort of 811 men undergoing Holmium enucleation of the prostate (HoLEP) (January 2021-July 2022) were identified. Advanced preoperative testing was defined as prostate health index (PHI), prostate MRI, and/or negative preoperative biopsy. Descriptive statistics (Whitney-Mann U test, Chi-squared test) and multivariable logistic regression were performed.
iPCa and icsPCa detection rates were 12.8% (104/811) and 4.4% (36/811), respectively. Advanced preoperative testing (406/811, 50%) was associated with younger age and higher (prostate specific antigen) PSA, prostate volume, and PSA density. On multivariable analysis, PHI ≥ 55 was associated with iPCa (OR 6.91, 95% CI 1.85-26.3, p = 0.004), and % free PSA (%fPSA) was associated with icsPCa (OR 0.83, 95% CI 0.67, 0.94, p = 0.01). GG1 disease comprised the majority of iPCa (65%, 68/104) with median 1% involvement. iPCa patients were followed with active surveillance (median follow up 9.3 months), with higher risk patients receiving prostate MRI and confirmatory biopsy. Three patients proceeded to radical prostatectomy or radiation.
In the era of MRI and advanced biomarkers, the majority of iPCa following HoLEP is low volume GG1 suitable for active surveillance. A tentative follow-up strategy is proposed. Patients with PHI ≥ 55 or low %fPSA, even with negative prostate MRI, can consider preoperative prostate biopsy before HoLEP.
评估偶然发现的前列腺癌（iPCa）和偶然发现的临床显著前列腺癌（icsPCa，GG≥2 PCa）的当代术前危险因素和随后的术后管理。
回顾性分析了 811 名接受钬激光前列腺剜除术（HoLEP）的男性（2021 年 1 月至 2022 年 7 月）。高级术前检查定义为前列腺健康指数（PHI）、前列腺 MRI 和/或阴性术前活检。采用描述性统计（Whitney-Mann U 检验、卡方检验）和多变量逻辑回归进行分析。
iPCa 和 icsPCa 的检出率分别为 12.8%（104/811）和 4.4%（36/811）。高级术前检查（406/811，50%）与年龄较小、较高的前列腺特异性抗原（PSA）、前列腺体积和 PSA 密度有关。多变量分析显示，PHI≥55 与 iPCa 相关（OR 6.91，95%CI 1.85-26.3，p=0.004），%游离 PSA（%fPSA）与 icsPCa 相关（OR 0.83，95%CI 0.67, 0.94，p=0.01）。iPCa 中以 GG1 疾病为主（65%，68/104），中位数为 1%受累。iPCa 患者接受主动监测（中位随访 9.3 个月），高危患者接受前列腺 MRI 和确认性活检。有 3 名患者接受了根治性前列腺切除术或放疗。
在 MRI 和高级生物标志物时代，HoLEP 后大多数 iPCa 为低体积 GG1，适合主动监测。提出了一种试探性的随访策略。即使前列腺 MRI 阴性，PHI≥55 或 %fPSA 较低的患者，可考虑在 HoLEP 前行前列腺活检。
