Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

Abstract

Background: This study aimed to explore the prevalence and clinical risk factors in patients diagnosed with incidental prostate cancer (IPC) during certain surgeries (transurethral resection of the prostate [TURP], open prostatectomy [OP], and holmium laser enucleation of the prostate [HoLEP]) after clinically suspected benign prostatic hyperplasia (BPH).Materials and Methods: Literature search of the MEDILINE, Web of Science, Embase, and Cochrane Library databases was performed to identify eligible studies published before June 2021. Multivariate adjusted odds ratios (ORs) and associated 95% confidence intervals (CIs) of the prevalence and clinical risk factors of IPC were calculated using random or fixed-effect models. Results: Twenty-three studies were included in the meta-analysis. Amongst the 94.783 patients, IPC was detected in 24.715 (26.1%). Results showed that the chance of IPC detection (10%, 95% CI: 0.07-4.00; P<0.001; I2=97%) in patients treated with TURP is similar to that of patients treated with HoLEP (9%, 95% CI: 0.07-0.11; P<0.001; I2=81.4%). However, the pooled prevalence estimate of patients treated with OP was 11% (95% CI: -0.03-0.25; P=0.113; I2=99.1%) with no statistical significance. We observed increased incidence of IPC diagnosis after BPH surgery amongst patients with higher prostatespecific antigen (PSA) level (OR: 1.13, 95% CI: 1.04-1.23; P=0.004; I2=89%), whereas no effect of age (OR: 1.02, 95% CI: 0.97-1.06; P=0.48; I2=78.8%) and prostate volume (OR: 0.99, 95% CI: 0.96-1.03; P=0.686; I2=80.5%) were observed. Conclusions: The prevalence of IPC was similar amongst patients undergoing TURP, HoLEP, and OP for presumed BPH. Interestingly, increased PSA level was the only independent predictor of increasing risk of IPC after BPH surgery rather than age and prostate volume. Hence, future research should focus on predictors which accurately foretell the progression of prostate cancer to determine the optimal treatment for managing patients with IPC after BPH surgery.

Renaming Grade Group 1 Prostate “Cancer” From a Pathology Perspective: A Call for Multidisciplinary Discussion

“…50 Likewise, nonlethal prostate neoplasms can be incidentally encountered in surgeries for benign prostatic hyperplasia (BPH) and cystoprostatectomy (CP) for bladder cancer. [51][52][53][54] Even at autopsy, latent GG 1 prostate cancers are extremely common. 55,56 These inconsequential nonlethal prostate neoplasms inflate the prevalence of prostate cancer, which is currently the leading cancer diagnosis in men, yet only about 3% actually die of the disease.…”

“…Most prostate biopsies are performed for elevated PSA and because it is not specific for cancer, a rise due to inflammation or other causes may lead to the sampling of nonlethal microfocal tumors resulting in the unfortunate new label of a “prostate cancer patient” 50 . Likewise, nonlethal prostate neoplasms can be incidentally encountered in surgeries for benign prostatic hyperplasia (BPH) and cystoprostatectomy (CP) for bladder cancer 51–54 . Even at autopsy, latent GG 1 prostate cancers are extremely common 55,56 …”

“…Any cancer is typically perceived to some degree as significant by patients, their families, and the treating physicians. “Incidental prostate cancer” is way too common in prostate surgeries encountered in 26% of BPH surgeries and 24% to 32% of CPs for bladder cancer 52–54 . A simple renaming may eliminate or considerably reduce overdiagnosis and reporting GG 1 as cancer, especially in the presence of only a few well-formed neoplastic glands 72 …”

Incidental prostate cancer after holmium laser enucleation of the prostate: Critical analysis of independent risk factors and impact on surgical outcomes

“…Autopsy samples have revealed that approximately 40% of men over 60 years old and nearly 60% of men over 80 years old have prostate cancer. 1,2 Although prostate-specific antigen (PSA) testing has greatly improved the diagnosis and treatment of prostate cancer, reducing the incidence of iPCa by about 65%, it is important to inform patients about the possibility of this diagnosis after surgical interventions for BPH. 1 A review conducted by Yilmaz et al demonstrated a rate of iPCa ranging from 5.64% to 23.3% after holmium laser enucleation of the prostate (HoLEP).…”

“…1,2 Although prostate-specific antigen (PSA) testing has greatly improved the diagnosis and treatment of prostate cancer, reducing the incidence of iPCa by about 65%, it is important to inform patients about the possibility of this diagnosis after surgical interventions for BPH. 1 A review conducted by Yilmaz et al demonstrated a rate of iPCa ranging from 5.64% to 23.3% after holmium laser enucleation of the prostate (HoLEP). 3 A temporal analysis noted that older patients have an increased incidence of grade group (GG) 1 iPCa that was associated with decrease in rate of preoperative prostate biopsy.…”