Incidental Prostate Cancer and HoLEP Outcomes: Critical Analysis of Risk Factors and Surgical Impact

What is it about?

The study evaluated the impact of incidental prostate cancer (iPCa) and its different grade group (GG) on the surgical outcomes of holmium laser enucleation of the prostate (HoLEP). A total of 417 patients were analyzed, with 40 (9.6%) having iPCa, of which 29 (72.5%) were clinically nonsignificant and 11 (27.5%) were clinically significant. Hypertension was significantly associated with overall prostate cancer diagnosis. Most cases of iPCa were GG1, and 34 (85%) were managed with active surveillance. The incidence of acute urinary retention, urinary tract infection, bladder neck stenosis, and urethral stricture was similar among the three groups of patients. The median IPSS, Qmax, and post-void residual urine were also similar at 1 year of follow-up. The study highlights the importance of informing patients about the possibility of detecting iPCa during surgical management for benign prostatic hyperplasia (BPH).

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Why is it important?

This research is important because it provides valuable insights into the detection of incidental prostate cancer (iPCa) during holmium laser enucleation of the prostate (HoLEP) procedures for benign prostatic hyperplasia (BPH). The study highlights the prevalence of iPCa and identifies potential risk factors associated with its detection. Key Takeaways: 1. A total of 417 patients were analyzed, with 40 (9.6%) patients having iPCa. 2. Most cases of iPCa were GG1, and 34 (85%) were managed with active surveillance. 3. Hypertension was significantly associated with the overall prostate cancer diagnosis. 4. Preoperative prostate biopsy and PSA level, prostate size, and baseline PSA density were not associated with increased risk of iPCa. 5. The incidence of acute urinary retention, urinary tract infection, bladder neck stenosis, and urethral stricture was similar among the groups of patients in accordance with the pathology results after HoLEP. 6. A negative preoperative MRI and prostate biopsy can miss clinically significant prostate cancer in some patients.