Incidental prostate cancer after holmium laser enucleation of the prostate: incidence and predictive factors for clinical progression

Klein, C.; Marquette, T.; Capon, G.; Yacoub, M.; Bernhard, Jean‐Christophe; Bladou, Franck; Robert, G.

doi:10.1007/s10147-022-02156-2

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…Klein C et al examined the predictive factors for iPCa progression after HoLEP, and reported that post-operative PSA level was significantly associated with iPCa progression (OR: 2.35, p < 0.001) [27]. In particular, post-operative PSA ≥ 2 ng/mL was the only predictor of iPCa progression, thus requiring close monitoring or early definite treatment.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Multiparametric Magnetic Resonance Imaging on Treatment Strategies for Incidental Prostate Cancer after Holmium Laser Enucleation of the Prostate

Choi

Song

2023

JCM

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Purpose: To investigate the impact of multiparametric magnetic resonance imaging (mpMRI) on treatment strategies for incidental prostate cancer (iPCa) after holmium enucleation of the prostate (HoLEP); Methods: Data from 1781 men who underwent HoLEP for clinical bladder outlet obstruction between September 2009 and March 2022 were reviewed retrospectively. Among patients with confirmed iPCa, those with prostate-specific antigen (PSA) levels < 10 ng/mL and who underwent mpMRI 3 months after HoLEP were included. Pathologic results, including Gleason grade (GG) and tumor volume, were identified. mpMRI was interpreted using the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2). Treatment strategies for iPCa according to GG alone, or according to a combination of Gleason grade and mpMRI, were analyzed and compared. Results: Of 1764 men with serum PSA levels < 10 ng/mL, iPCa was confirmed in 64 (3.6%) after HoLEP. Of the 62 men who underwent mpMRI, the median (IQR) age at the time of HoLEP was 72.5 (66.5–78.0) years. The median PSA level and prostate volume were 3.49 (1.82–5.03) ng/mL and 49.6 (38.5–85.4) cm3, respectively. The pathologic results of iPCa were as follows: GG1 = 42 (67.7%), GG2 = 13 (21.0%), GG3 = 2 (3.2%), GG4 = 1 (1.6%), and GG5 = 4 (6.5%). Of the patients with GG1 and GG2, 78.6% (33/42) and 53.8% (7/13), respectively, underwent active surveillance (AS). However, of 42 patients with GG1, 27 (64.3%) had a PI-RADSv2 score of 2, and 24 (88.9%) of them underwent AS. Of the 13 patients with GG2, 4 (80%) with a PI-RADSv2 score of 2 underwent AS. All patients with GG 3–5 were clinically expected to have locally advanced PCa and be treated with radiotherapy and/or ADT. Conclusions: For patients with iPCa of GG 1–2 after HoLEP, mpMRI helps to establish a treatment strategy by allowing risk stratification to select those who should be considered for AS or active treatment.

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Section: Discussionmentioning

confidence: 99%

The Impact of Multiparametric Magnetic Resonance Imaging on Treatment Strategies for Incidental Prostate Cancer after Holmium Laser Enucleation of the Prostate

Choi

Song

2023

JCM

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“…Considering the T stage of iPCa by HoLEP, Klein et al demonstrated that patients with T1a and PSA < 2 ng/mL were at very low risk of progression, while patients with T1b and PSA > 2 ng/mL had a risk of progression significantly. 3 In the postoperative period, worthwhile options of treatments or a close follow-up for iPCa can be advised, especially in patients with T1b stage and high PSA levels above 2 ng/mL. Besides PSA levels, the T stage can help predict the risk of progression.…”

Section: Editorial Commentmentioning

confidence: 99%

“…Klein et al. reported that the rate of iPCa was 10.7% ( n = 134/1247) in patients who underwent HoLEP, and pPSA >2 ng/mL was the independent risk factor for iPCa progression after HoLEP 3 . Although we should consider the oncological management individually among various treatment options, clinicians should carefully monitor pPSA and recognize the value range of pPSA from 1.2 to 2 ng/mL as a vital characteristic of PCa after HoLEP.…”

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confidence: 99%

Editorial comment on Prostate‐specific antigen follow‐up and management for patients undergoing holmium laser enucleation of the prostate

Sekito,

Sadahira

2023

Int J of Urology

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“…They concluded that T1a/b patients tend to live longer than T1c patients and that they could be considered for watchful waiting instead of active treatment in many cases [ 33 ]. Most recently, Klein et al in 2022 reviewed the management of iPCa with an incident rate of 10.7% in a large retrospective cohort [ 3 ]. Interestingly, in this cohort, there was a much higher risk of progression of those diagnosed with iPCa at a rate of 18.6%.…”

Section: Reviewmentioning

confidence: 99%

“…In rare cases, PCa is identified incidentally (iPCa) after surgical treatment of lower urinary tract symptoms (LUTS) in patients with BPH. IPCa is clinically imperceptible and is discovered upon microscopic examination of resected tissue after BPH surgery [ 3 ]. These cancers are currently classified as either T1a or T1b where cancer is found in less than or more than 5% of resected tissue, respectively.…”

Section: Introductionmentioning

confidence: 99%

Current Trends in Incidence and Management of T1a and T1b Prostate Cancer

Khan¹,

Imam²,

Hernandez³

2023

Cureus

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Prostate cancer (PCa) identified incidentally (iPCa) after surgical treatment for symptomatic benign prostatic hyperplasia (BPH) causing lower urinary tract symptoms (LUTS) is considered low risk by the most current guidelines. Management protocols for iPCa are conservative and are identical to other prostate cancers classified as having favorable prognoses. The objectives of this paper are to discuss the incidence of iPCa stratified by BPH procedure, to highlight predictors of cancer progression, and to propose potential modifications to mainstream guidelines for the optimal management of iPCa. The correlation between the rate of iPCa detection and the method of BPH surgery is not clearly defined. Old age, small prostate volume, and high pre-operative prostate-specific antigen (PSA) are associated with an increased likelihood of detecting iPCa. PSA and tumor grade are strong predictors of cancer progression and can be used along with magnetic resonance imaging (MRI) and potential confirmatory biopsies to determine disease management. In instances that iPCa requires treatment, radical prostatectomy (RP), radiation therapy, and androgen deprivation therapy all have oncologic benefits but may be associated with increased risk after the BPH surgery. It is advised that patients with low to favorable intermediate-risk prostate cancer undergo post-operative PSA measurement and prostate MRI imaging before electing to choose between observation, surveillance without confirmatory biopsy, immediate confirmatory biopsy, or active treatment. Subdividing the binary T1a/b cancer staging into more categories with ranging percentages of malignant tissue would be a helpful first step in tailoring the management of iPCa.

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Incidental prostate cancer after holmium laser enucleation of the prostate: incidence and predictive factors for clinical progression

Cited by 6 publications

References 27 publications

The Impact of Multiparametric Magnetic Resonance Imaging on Treatment Strategies for Incidental Prostate Cancer after Holmium Laser Enucleation of the Prostate

The Impact of Multiparametric Magnetic Resonance Imaging on Treatment Strategies for Incidental Prostate Cancer after Holmium Laser Enucleation of the Prostate

Editorial comment on Prostate‐specific antigen follow‐up and management for patients undergoing holmium laser enucleation of the prostate

Current Trends in Incidence and Management of T1a and T1b Prostate Cancer

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