Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis

Cheng, Bryan Kwun-Chung; Castellani, Daniele; Chan, Ivan Sik-Hei; Baker, Abu; Gauhar, Vineet; Wroclawski, Marcelo Langer; Santamaria, Hegel Trujillo; Tanıdır, Yılören; Enikeev, Dmitry; Chan, Vinson Wai-Shun; Ng, Chi‐Fai; Herrmann, Thomas; Teoh, Jeremy Yuen‐Chun

doi:10.1007/s00345-021-03756-9

Cited by 14 publications

(26 citation statements)

References 41 publications

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“…A large prostate volume in preoperative assessment might indicate the true hyperplasia and the odds would decrease with every 10-mL change in prostatic volume. 15 This conclusion was similar to that in our study. As for tools for assessment, previous literature demonstrated that although both transabdominal and transrectal ultrasounds could provide information to predict the resected weight of prostate, the latter could provide the closer approximation.…”

Section: Discussionsupporting

confidence: 93%

“…In current 17 studies, PSA possessed a solid role in predicting iPCa out of surgeries for benign prostate. 15 In our multivariable logit model, preoperative PSA remained to be the most powerful one predicting the existence of iPCa from benign biopsies. A threshold of 9.025 ng/mL could serve as a reference to possible iPCa and the sensitivity of this value was more prominent in men below the threshold age.…”

Section: Discussionmentioning

confidence: 82%

“…In a large-scale observations study, smaller resection weight in TURP would be associated with future detection of prostate cancer, especially low-grade one. 16 However, out of 6 studies of transurethral surgeries, 15 one of them demonstrated the inverse relation between resected weight and iPCa and the others could not conclude significant relations. Herein, the assumption that the resected weight would be related to the detection of iPCa was still inconclusive and undetermined in current medical evidence.…”

Section: Discussionmentioning

confidence: 98%

“…In HoLEP, the rate in our study was 16%. However, according to the meta-analysis out of 50 studies and a total of 27,925 men after HoLEP, 15 iPCa rate was assessed to be around 8.1%, suffering from remarkable heterogeneity among studies. Some of studies included in the meta-analysis were conducted before the US Food and Drug Administration (FDA) approved the use of PSA in testing asymptomatic men for prostate cancer, and some of them were conducted before the yearly PSA screening was encouraged in men aged over 50 yo.…”

Section: Discussionmentioning

confidence: 99%

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Incidental Prostate Cancer from Prostate with Benign Biopsies: A Predictive and Survival Analysis from Cohort Study

Yang¹,

Lin²,

WC³

et al. 2022

IJGM

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Purpose This cohort was to evaluate incidental prostate cancer (iPCa) from men with preoperative benign biopsies and demonstrate their outcomes under different managements. Patients and Methods Between 2015 and 2017, we analyzed the risk factors having iPCa from surgical specimens from men provided with benign preoperative biopsies of their prostates. Furthermore, we compared the survival outcomes according to the different managements after iPCa was diagnosed. Receiver operating characteristic (ROC) curve was utilized to find the best thresholds. Univariable and multivariable nested logit regression were performed to estimate the effect size of different independent variables. Odds ratio (OR) was expressed with 95% confidence interval, and the alpha level was 5%. Results In 295 men we enrolled, there were 57 (19%) men having iPCa from surgical specimens. In univariable logit regression, we found significant variables of age, PSA, prostatic volume, PSA velocity ≥ 0.75 ng/mL/year for 3 years, taking 5α reductase inhibitors, abnormal digital rectal examination, cores of biopsy and surgical methods. In multivariable model, PSA was the strongest variable predicting iPCa (OR 3.81 [2.04–7.07]; Wald: 17.75; p < 0.001). In ROC curve, the best threshold was 9.025 ng/mL (area under curve: 0.95; sensitivity: 0.947; specificity: 0.866). In Kaplan–Meier curve of 27.89-month follow-up, robot-assisted simple prostatectomy (RASP) can provide similar PSA progression-free period as robot-assisted radical prostatectomy (RARP) following transurethral surgeries in organ-confined cancer (Log rank test, p = 0.293), and both of them were better than external-beam radiation therapy (RT) following transurethral surgeries (Log rank test, p < 0.001). Conclusion PSA was the strongest variable to predict iPCa out of prostate with preoperative benign biopsies. RASP was parallel to RARP following transurethral surgeries in organ-confined cancer in the short term.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Incidental Prostate Cancer from Prostate with Benign Biopsies: A Predictive and Survival Analysis from Cohort Study

Yang¹,

Lin²,

WC³

et al. 2022

IJGM

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“…The nadir PSA level after TURP is theoretically produced from the remaining prostate tissue, including PZ, CZ, and residual TZ, if any. Compared with TURP, TUEP can remove the adenoma more completely and may generate a new nadir PSA secreted only from PZ+CZ (13,14). The nadir PSA level after complete TUEP may serve as a new indicator for not only the completeness of TUEP but also the secretory activity in the remaining prostate.…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of Nadir Serum Prostate-Specific Antigen Levels After Transurethral Enucleation of the Prostate

Cheng

Hong

et al. 2022

Front. Oncol.

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ObjectiveProstate-specific antigen levels after transurethral enucleation of the prostate may serve as indicators of residual cancer foci. The objective of this study was to investigate the association between the post-transurethral enucleation of the prostate nadir prostate-specific antigen level and prostate cancer.Materials and MethodsWe retrospectively reviewed the data of 428 men who underwent transurethral enucleation of the prostate between March 2015 and April 2021. Based on the following exclusion criteria, we excluded 106 men from our analysis: men with metastatic prostate cancer, incomplete transurethral enucleation of the prostate, and missing prostate-specific antigen or prostate size data. Three hundred and twenty-two patients were finally enrolled in our study. These patients were classified into four groups according to the surgical pathology: benign, transition zone (cancer only in the adenoma or transition zone), peripheral zone, and transition and peripheral zones. The optimal cutoff post-transurethral enucleation of the prostate nadir prostate-specific antigen level that predicted residual prostate cancer was determined using receiver operating characteristic curve analysis.ResultsIn total, 71 (22.0%) men exhibited prostate cancer (median follow-up, 38.0 months). The benign and combined cancer groups showed similar adenoma removal rates (103.0% and 106.7%, respectively). The median nadir prostate-specific antigen levels after transurethral enucleation of the prostate were 0.76, 0.63, 1.79, and 1.70 ng/ml in the benign, transition zone, peripheral zone, and transition and peripheral zone groups, respectively (p < 0.001), with no difference between the benign and transition zone groups (p = 0.458); this suggested that complete transurethral enucleation of the prostate removed all cancer nests in the adenoma in the transition zone group. Receiver operating characteristic curve analysis showed that nadir prostate-specific antigen ≧1.7 ng/ml predicted residual cancer (area under the curve: 0.787) or cancer with a Gleason score of ≧7 (area under the curve: 0.816) in the remaining prostate. Limitations include the retrospective design and the perioperative peripheral zone biopsy rate.ConclusionsThe post-transurethral enucleation of the prostate nadir prostate-specific antigen ≧1.7 ng/ml after complete transurethral enucleation of the prostate can predict significant residual cancer. Prostate cancer patients with low post-transurethral enucleation of the prostate prostate-specific antigen levels can be conservatively managed.

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

Porto,

Blachman‐Braun,

Ajami

et al. 2023

BJUI Compass

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ObjectivesThe 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 MethodsA 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.ResultsA 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.ConclusionThe 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.

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Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis

Cited by 14 publications

References 41 publications

Incidental Prostate Cancer from Prostate with Benign Biopsies: A Predictive and Survival Analysis from Cohort Study

Incidental Prostate Cancer from Prostate with Benign Biopsies: A Predictive and Survival Analysis from Cohort Study

Clinical Implications of Nadir Serum Prostate-Specific Antigen Levels After Transurethral Enucleation of the Prostate

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

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