Modern predictors and management of incidental prostate cancer at holmium enucleation of prostate.

Autor: Li EV; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA., Lee MS; Department of Urology, Ohio State University College of Medicine, Columbus, Ohio, USA., Guo J; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA., Dean N; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA., Kumar S; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA., Mi X; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA., Zhou R; Feinberg School of Medicine, Department of Pathology, Northwestern University, Chicago, Illinois, USA., Neill C; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA., Yang X; Feinberg School of Medicine, Department of Pathology, Northwestern University, Chicago, Illinois, USA., Ross AE; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA., Krambeck AE; Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: The Prostate [Prostate] 2024 Dec; Vol. 84 (16), pp. 1427-1433. Date of Electronic Publication: 2024 Aug 18.
DOI: 10.1002/pros.24781
Abstrakt: Background: 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).
Methods: 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.
Results: 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.
Conclusions: 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.
(© 2024 The Author(s). The Prostate published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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