Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes
Abstract Objectives The objectives of this study are to evaluate 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) and, furthermore, to assess the independent risk factors associated with t...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | BJUI Compass |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/bco2.306 |
| _version_ | 1797265491801145344 |
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| author | Joao G. Porto Ruben Blachman‐Braun Tarek Ajami Mohamadhusni Zarli Ryan Chen Thiago Furtado Robert Marcovich Dipen J. Parekh Hemendra N. Shah |
| author_facet | Joao G. Porto Ruben Blachman‐Braun Tarek Ajami Mohamadhusni Zarli Ryan Chen Thiago Furtado Robert Marcovich Dipen J. Parekh Hemendra N. Shah |
| author_sort | Joao G. Porto |
| collection | DOAJ |
| description | Abstract Objectives The objectives of this study are to evaluate 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) and, furthermore, to assess the independent risk factors associated with the detection of iPCa. Patients (or materials) and Methods A retrospective chart review was conducted at a single institution for HoLEP cases that were performed between 2017 and 2022. Patients with a preoperative diagnosis of prostate cancer and those without baseline prostate‐specific antigen (PSA) levels within 1 year were excluded. Four hundred seventeen patients were divided into three groups: benign prostatic hyperplasia—377; clinically insignificant (GG 1)—29; and clinically significant prostate cancer (GG 2–5)—11. The preoperative parameters analysed included age, body mass index, race/ethnicity, use of 5‐alpha‐reductase inhibitors, PSA, prostate size, PSA density, and history of negative prostate biopsy. To evaluate the association between clinical and demographic variables, a multivariable‐adjusted logistic regression analysis was performed. We also assessed intraoperative and post‐operative outcomes among these three groups. Results A total of 417 patients were analysed; 40 (9.6%) patients had iPCa, of which 29 (72.5%) and 11 (27.5%) were clinically nonsignificant and significant prostate cancer, respectively. Of all the demographic and preoperative variables analysed, hypertension was significantly associated with overall prostate cancer diagnosis (p < 0.05), and no other variable including patient age, preoperative PSA, PSA density, prostate size, or prior prostate biopsy were associated with increased risk of overall prostate cancer or clinically significant prostate cancer diagnosis. Most cases of iPCa were GG1, and 34 (85%) were managed with active surveillance. Conclusion The rate of iPCa after HoLEP was 9.6%, with most cases being GG 1 (72.5%) and managed through active surveillance. Age, prostate size, baseline PSA, and prior negative prostate biopsies were not associated with increased risk of iPCa. |
| first_indexed | 2024-04-25T00:45:39Z |
| format | Article |
| id | doaj.art-e0ae781b608642378b4f05264e4574c5 |
| institution | Directory Open Access Journal |
| issn | 2688-4526 |
| language | English |
| last_indexed | 2024-04-25T00:45:39Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj.art-e0ae781b608642378b4f05264e4574c52024-03-12T04:55:08ZengWileyBJUI Compass2688-45262024-03-015337438110.1002/bco2.306Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomesJoao G. Porto0Ruben Blachman‐Braun1Tarek Ajami2Mohamadhusni Zarli3Ryan Chen4Thiago Furtado5Robert Marcovich6Dipen J. Parekh7Hemendra N. Shah8Desai Sethi Urology Institute, Miller School of Medicine University of Miami Miami Florida USADesai Sethi Urology Institute, Miller School of Medicine University of Miami Miami Florida USADesai Sethi Urology Institute, Miller School of Medicine University of Miami Miami Florida USADr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University Fort Lauderdale Florida USADesai Sethi Urology Institute, Miller School of Medicine University of Miami Miami Florida USAFaculdade de Ciências Médicas de Minas Gerais Belo Horizonte BrazilDesai Sethi Urology Institute, Miller School of Medicine University of Miami Miami Florida USADesai Sethi Urology Institute, Miller School of Medicine University of Miami Miami Florida USADesai Sethi Urology Institute, Miller School of Medicine University of Miami Miami Florida USAAbstract Objectives The objectives of this study are to evaluate 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) and, furthermore, to assess the independent risk factors associated with the detection of iPCa. Patients (or materials) and Methods A retrospective chart review was conducted at a single institution for HoLEP cases that were performed between 2017 and 2022. Patients with a preoperative diagnosis of prostate cancer and those without baseline prostate‐specific antigen (PSA) levels within 1 year were excluded. Four hundred seventeen patients were divided into three groups: benign prostatic hyperplasia—377; clinically insignificant (GG 1)—29; and clinically significant prostate cancer (GG 2–5)—11. The preoperative parameters analysed included age, body mass index, race/ethnicity, use of 5‐alpha‐reductase inhibitors, PSA, prostate size, PSA density, and history of negative prostate biopsy. To evaluate the association between clinical and demographic variables, a multivariable‐adjusted logistic regression analysis was performed. We also assessed intraoperative and post‐operative outcomes among these three groups. Results A total of 417 patients were analysed; 40 (9.6%) patients had iPCa, of which 29 (72.5%) and 11 (27.5%) were clinically nonsignificant and significant prostate cancer, respectively. Of all the demographic and preoperative variables analysed, hypertension was significantly associated with overall prostate cancer diagnosis (p < 0.05), and no other variable including patient age, preoperative PSA, PSA density, prostate size, or prior prostate biopsy were associated with increased risk of overall prostate cancer or clinically significant prostate cancer diagnosis. Most cases of iPCa were GG1, and 34 (85%) were managed with active surveillance. Conclusion The rate of iPCa after HoLEP was 9.6%, with most cases being GG 1 (72.5%) and managed through active surveillance. Age, prostate size, baseline PSA, and prior negative prostate biopsies were not associated with increased risk of iPCa.https://doi.org/10.1002/bco2.306active surveillancebenign prostatic hyperplasiaholmium laser enucleation of the prostateincidental prostate cancerlower tract urinary symptoms |
| spellingShingle | Joao G. Porto Ruben Blachman‐Braun Tarek Ajami Mohamadhusni Zarli Ryan Chen Thiago Furtado Robert Marcovich Dipen J. Parekh Hemendra N. Shah Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes BJUI Compass active surveillance benign prostatic hyperplasia holmium laser enucleation of the prostate incidental prostate cancer lower tract urinary symptoms |
| title | Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes |
| title_full | Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes |
| title_fullStr | Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes |
| title_full_unstemmed | Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes |
| title_short | Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes |
| title_sort | incidental prostate cancer after holmium laser enucleation of the prostate critical analysis of independent risk factors and impact on surgical outcomes |
| topic | active surveillance benign prostatic hyperplasia holmium laser enucleation of the prostate incidental prostate cancer lower tract urinary symptoms |
| url | https://doi.org/10.1002/bco2.306 |
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