We have located links that may give you full text access.
Incidental prostate cancer diagnosis is common after holmium laser enucleation of the prostate.
Urology 2023 December 2
OBJECTIVE: To determine the incidence of incidental prostate cancer detection (iPCa) after holmium laser enucleation of the prostate (HoLEP). The published rate of iPCa after HoLEP is widely variable from 7-23% and we aim to define preoperative risk factors for iPCa to inform risk adjusted preoperative evaluation for prostate cancer.
METHODS: Consecutive patients undergoing HoLEP from 2018-2022 were included and comprehensive clinical data abstracted from a prospectively maintained database. iPCa was defined as a diagnosis of PCa on pathologic examination of the HoLEP specimen. Patients with and without iPCa were compared with respect to pre-operative clinical variables.
RESULTS: Of 913 HoLEP patients, 183 (20%) were diagnosed with iPCa. Most patients (95%) had a pre-operative PSA, 9% had negative MRI, and 30% had negative prostate biopsy. On multivariable analysis, PSA density (OR 1.06; 95% CI 1.03, 1.10; p<0.001), preoperative biopsy status (OR 0.47, CI 0.30, 0.75; p=0.002), and current 5-alpha reductase inhibitor (5-ARI) use (OR 0.64, CI 0.43, 0.97; p=0.034), were associated with iPCa diagnosis.
CONCLUSIONS: In a significantly pre-screened population, we identified a 20% rate of iPCa after HoLEP. Preoperative characteristics associated with iPCa diagnosis included increasing age, increasing PSA density, and current 5-ARI use. However, these factors alone may be of limited clinical utility to prospectively identify patients at high risk of iPCa diagnosis. We suggest and advocate for development of a standardized, risk adapted evaluation focused on expanded use of imaging and selective biopsy to prioritize identification of clinically significant prostate cancers prior to non-oncologic surgery.
METHODS: Consecutive patients undergoing HoLEP from 2018-2022 were included and comprehensive clinical data abstracted from a prospectively maintained database. iPCa was defined as a diagnosis of PCa on pathologic examination of the HoLEP specimen. Patients with and without iPCa were compared with respect to pre-operative clinical variables.
RESULTS: Of 913 HoLEP patients, 183 (20%) were diagnosed with iPCa. Most patients (95%) had a pre-operative PSA, 9% had negative MRI, and 30% had negative prostate biopsy. On multivariable analysis, PSA density (OR 1.06; 95% CI 1.03, 1.10; p<0.001), preoperative biopsy status (OR 0.47, CI 0.30, 0.75; p=0.002), and current 5-alpha reductase inhibitor (5-ARI) use (OR 0.64, CI 0.43, 0.97; p=0.034), were associated with iPCa diagnosis.
CONCLUSIONS: In a significantly pre-screened population, we identified a 20% rate of iPCa after HoLEP. Preoperative characteristics associated with iPCa diagnosis included increasing age, increasing PSA density, and current 5-ARI use. However, these factors alone may be of limited clinical utility to prospectively identify patients at high risk of iPCa diagnosis. We suggest and advocate for development of a standardized, risk adapted evaluation focused on expanded use of imaging and selective biopsy to prioritize identification of clinically significant prostate cancers prior to non-oncologic surgery.
Full text links
Related Resources
Trending Papers
Renin-Angiotensin-Aldosterone System: From History to Practice of a Secular Topic.International Journal of Molecular Sciences 2024 April 5
Albumin: a comprehensive review and practical guideline for clinical use.European Journal of Clinical Pharmacology 2024 April 13
Revascularization Strategy in Myocardial Infarction with Multivessel Disease.Journal of Clinical Medicine 2024 March 27
Clinical practice guidelines on the management of status epilepticus in adults: A systematic review.Epilepsia 2024 April 13
Interstitial Lung Disease: A Review.JAMA 2024 April 23
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app