<p>The Management of Patients Diagnosed with Incidental Prostate Cancer: Narrative Review</p>

Abstract

5-14% of patients underwent surgery for benign prostate hyperplasia harboring prostate cancer (PCa) focus. The best management of incidental prostate cancer (iPCa) has been debated. The decision "treatment or no treatment" should be determined by predictors which accurately foretell PCa progression after transurethral resection of the prostate (TURP). The purpose of this study is to review the available data that can be useful in daily clinical judgment. Transrectal ultrasound prostate biopsy (TRUSBx) did not provide further Gleason score (GS) data in most patients diagnosed with iPCa. TRUSBX may be useful before active surveillance, but not in all following radical prostatectomy. The decision "treatment or no treatment" should be dependent on the expected chance of having residual cancer and clinical progression. Prostate-specific antigen (PSA) levels before and after TURP are good predictors of residual cancer after TURP. Pathological report of T0 is most likely seen in patients with low PSA density after TURP and indistinguishable lesion on multiparametric magnetic resonance imaging. The decision "treatment vs no treatment" is judged by life expectancy, tumor characteristic in the pathology report of TURP sample and PSA level following TURP. Active surveillance should be contemplated in patients with iPCa who have both prostate-specific antigen density ≤0.08 after TURP and indistinguishable cancer lesion on multiparametric magnetic resonance imaging. Patients who do not meet the criteria for active surveillance are candidates for radical prostatectomy or radiotherapy (RT). Radical prostatectomy could be peacefully done after TURP with somewhat greater morbidity. RT in patients who had a history of TURP could be safely done and is associated with acceptable quality of life.

Incidental prostate cancer after holmium laser enucleation of the prostate—A narrative review

“…Although there is evidence that the iPCa detection rate fell from 31% to 5.4% through PSA screening, one can expect to detect iPCa after BPH surgery in older men (Bhojani et al, 2015;Elkoushy et al, 2015). The incidence of iPCa after TURP has been reported to range from 5% to 14% (Abedi et al, 2020). Regarding the studies we reviewed, the rate of iPCa after HoLEP ranges between 5.64% and 23.3%.…”

Incidence of incidental cancer in transurethral resection of prostate specimens: a 10-year retrospective analysis

“…Various studies have reported that T1b stage IPCs have a worse prognosis than those at T1a stage [13]. The decision "treatment vs no treatment" is judged by life expectancy, tumor characteristic in the pathology report of TUR-P specimen and PSA level following TUR-P [21]. In light of this information, detailed histopathological and clinical evaluations can be considered of great importance to be able to make a correct diagnosis and for the formation of appropriate follow-up and treatment plans.…”

Holmium laser enucleation of the prostate in men on active surveillance for prostate cancer with refractory lower urinary tract symptoms secondary to enlarged prostates

“…Incidental detection of malignancy at the time of HoLEP ranges from 5% to 13% in men without a prior diagnosis of PCa, and there is evidence PSA has improved sensitivity for cancer progression in the post‐HoLEP setting 6–9 . The management of T1a‐b PCa incidentally discovered after transurethral resection of prostate (TURP) has been well documented with AS recommended for the majority of patients 10–12 . However, the management of men with known low‐risk PCa, clinically significant LUTS, and significantly enlarged prostates remains underexplored.…”