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

Yang, Che‐Hsueh; Lin, Yi‐Sheng; WC, Weng; CY, Hsu; MC, Tung; YC, Ou

doi:10.2147/ijgm.s357368

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…Predicting malignancy preoperatively by using T-RARP is challenging [20]. Based on our previous works [4,20] and the present one, the application of PSA to predict malignancy in either preoperative benign or no biopsies was robust. Interestingly, we observed different roles of PI-RADS scores in patients with and without preoperative biopsies.…”

Section: Discussionmentioning

confidence: 61%

“…In our experience, approximately 19% of men with incidental PCa undergo surgery for benign prostate enlargement, which greatly affects their quality of life [4]. In this cohort, 77% of men with benign preoperative biopsies but considered at a high risk of harboring PCa developed malignancy after T-RARP, and 73% of men considered at a high risk of harboring PCa but without biopsies developed PCa after T-RARP.…”

Section: Discussionmentioning

confidence: 86%

“…In our experience, approximately 40% of men undergo preoperative benign biopsies of PCa in surgical specimens after simple prostatectomy [4]. Theranostics is an emerging trend in the modern medical industry that combines therapeutics and diagnostics.…”

Section: Introductionmentioning

confidence: 99%

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Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Hsu,

Yang,

Tung

et al. 2023

Cancers

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Objective: This study aimed to explore the benefits of theranostic robot-assisted radical prostatectomy (T-RARP) for clinically highly suspicious prostate cancer (PCa) without proven biopsies. Material and Methods: Between February 2016 and December 2020, we included men with clinically highly suspicious PCa in this study. They were assessed to have possible localized PCa without any initial treatments, and were categorized into previous benign biopsies or without biopsies. Furthermore, another group of malignant biopsies with RARP in the same time frame was adopted as the control group. The endpoints were to compare the oncological outcome and functional outcome between malignant biopsies with RARP and T-RARP. p < 0.05 was considered to be significant. Results: We included 164 men with proven malignant biopsies treated with RARP as the control group. For T-RARP, we included 192 men. Among them, 129 were preoperatively benign biopsies, and 63 had no biopsies before T-RARP. Approximately 75% of men in the T-RARP group had malignant pathology in their final reports, and the other 25% had benign pathology. T-RARP provides several oncological advantages, such as a higher initial pathological T stage, lower Gleason grade, and lower odds of positive surgical margins. However, the biochemical recurrence rates were not significantly decreased. From our cohort, T-RARP (odds ratio with 95% confidence interval; erectile recovery: 3.19 (1.84–5.52), p < 0.001; continence recovery: 2.25 (1.46–3.48), p < 0.001) could result in better recovery of functional outcomes than malignant biopsies with RARP. Conclusions: For clinically highly suspicious PCa, T-RARP was able to detect around 75% of PCa cases and preserved their functional outcomes maximally. However, in 25% of men with benign pathology, approximately 6% would have incontinence and 10% would have erectile impairment. This part should be sufficiently informed of the potential groups considering T-RARP.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 86%

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Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Hsu,

Yang,

Tung

et al. 2023

Cancers

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“…A 10-year retrospective study from Pakistan of 2,386 men aged 25–98 years with a mean age of 68.51 ± 9.22 years reported an incidence rate of about 10.7%, with 90.1% of the patients being T1b, which is remarkably higher than the stage we reported (Janjua et al 2021 ). Among 295 men, 19% had a histopathological report indicating ICP (Yang et al 2022 ). There is inconsistency in the literature with the reported incidence rates of ICP from surgical specimens from men with presumed benign prostate hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

Incidence and associated factors for incidental prostate cancer among patients who underwent surgery for benign prostatic hyperplasia: first report from Somalia

Mohamed¹,

Abdullahi²,

Warsame³

et al. 2022

J Cancer Res Clin Oncol

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Background The incidence rate of incidental prostate cancer (IPC) differs significantly among the reported studies in the relevant literature. There is a scarcity of studies regarding IPC reported from Sub-Saharan African Countries, including Somalia. The present is the first study that evaluates the incidence and associated factors for IPC among patients who had surgery for benign prostatic hyperplasia at a tertiary hospital in Somalia. Method This retrospective study reviewed the data of 538 patients with benign prostate hyperplasia, 464 patients who underwent transurethral resection of the prostate (TURP), and 74 patients with open prostatectomy (OP) over 5 years. A binary logistic regression model was used to investigate the association between perioperative factors such as age, prostate volume, total prostate-specific antigen (TPSA) levels, type of surgery, specimen weight, and the finding of IPC. Results IPC was detected in 17.6%, 18.3% of TURP, and 13.5% of OP patients (p = 0.002). The mean age of the patients was 71.82 ± 7.4; IPC patients had a significantly higher mean age than the BPH group (74 ± 10.9 vs. 71.3 ± 10.8, p < 0.001). Sixty-two percent of the patients were T1b, while 57.8% had ISUP grade groups 1 and 2. Patients with T1a had significantly higher International Society of Urological Pathology (ISUP) grades 1 and 2 than those with T1b (69.4% in T1a vs. 50.8% in T1b, p < 0.001). Increased age, higher TPSA levels, low prostate volume, and specimen weight were independently associated with the finding of incidental prostate carcinoma (OR 1.978, 95% CI 0.95–1.60, P < 0.04; OR 1.839, 95% CI 0.99–2.02, P < 0.001; OR 1.457, 95% CI 0.7102.99, P < 0.001, OR 0.989, 95% CI 1.07–2.94, P = 0.01). IPC was most commonly managed by active surveillance (54.7%), followed by androgen deprivation therapy in 28.4%. The overall survival rate for a 5-year follow-up in the entire cohort was 79%. The cancer-specific mortality was 8.4%. Conclusion The study findings revealed a higher incidence and cancer-specific mortality rate of incidental prostate carcinoma. T1b stage, higher ISUP grade, older age, and higher preoperative TPSA were significantly associated with the overall mortality and cancer-specific mortality rate. More than half of the cases were managed by active surveillance, and it is a safe management strategy, particularly in low-income countries like Somalia.

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“…Traditionally, prostate cancer has been diagnosed using a sextant or systematic biopsy (SB), which may miss 20% to 30% of clinically significant prostate cancer (csPC) because of the random sampling approach [ 5 , 6 ]. Recently, Yang et al reported that in 295 men with benign preoperative biopsies undergoing TURP or simple prostatectomy, 57 (19%) were found to have prostate cancer incidentally [ 7 ]. With technical advances in multiparametric magnetic resonance imaging (mpMRI) and promotion by the European Society of Urogenital Radiology and American College of Radiology in the past decades, mpMRI has become an important imaging tool in the diagnostic pathway of prostate cancer [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Learning Curve of Transperineal MRI/US Fusion Prostate Biopsy: 4-Year Experience

Hsieh

Lin

et al. 2023

Life

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This study aimed to evaluate the learning curve of transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy in a team composed of a single surgeon, a single radiologist, and a single pathologist. We prospectively enrolled 206 patients undergoing MRI/US fusion prostate biopsy and divided them into four cohorts by the year of biopsy. We analyzed temporal changes in clinically significant prostate cancer (csPC) detection rate, percentage of positive cores on biopsy, and Gleason upgrading rate after radical prostatectomy. The csPC detection rate by MRI/US fusion targeted biopsy (TB) increased significantly (from 35.3% to 60.0%, p = 0.01). With increased experience, the csPC detection rates for small (≤1 cm) and anterior target lesions gradually increased (from 41.2% to 51.6%, p = 0.5; from 54.5% to 88.2%, p = 0.8, respectively). The percentage of positive cores on TB increased significantly (from 18.4% to 44.2%, p = 0.001). The Gleason upgrading rate gradually decreased (from 22.2% to 11.1%, p = 0.4). In conclusion, with accumulated experience and teamwork, the csPC detection rate by TB significantly increased. Multidisciplinary team meetings and a free-hand biopsy technique were the key factors for overcoming the learning curve.

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

Cited by 4 publications

References 28 publications

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Incidence and associated factors for incidental prostate cancer among patients who underwent surgery for benign prostatic hyperplasia: first report from Somalia

Learning Curve of Transperineal MRI/US Fusion Prostate Biopsy: 4-Year Experience

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