Temporal Trend in Incidental Prostate Cancer Detection at Surgery for Benign Prostatic Hyperplasia

Capogrosso, Paolo; Capitanio, Umberto; Vertosick, Emily; Ventimiglia, Eugenio; Chierigo, Francesco; Oreggia, Davide; Moretti, D.; Briganti, Alberto; Vickers, Andrew J.; Montorsi, Francesco; Salonia, Andrea

doi:10.1016/j.urology.2018.07.028

Cited by 44 publications

(45 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prostate-specific antigen (PSA) assessment, digital-rectal examination (DRE), and rebiopsies are performed frequently in order to switch to an invasive treatment when signs of progression appear [7,8]. However, due to the low detection rate of 4-9% of prostate cancer after surgical BPO treatment [9][10][11][12][13], data on oncological outcomes of IPC patients are scarce, especially of those managed with AS.…”

Section: Introductionmentioning

confidence: 99%

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Herden

Schwarte

Boedefeld³

et al. 2021

Urol Int

View full text Add to dashboard Cite

Introduction: Optimal treatment for incidental prostate cancer (IPC) after surgical treatment for benign prostate obstruction is still debatable. We report on long-term outcomes of IPC patients managed with active surveillance (AS) in a German multicenter study. Methods: HAROW (2008–2013) was designed as a noninterventional, prospective, health-service research study for patients with localized prostate cancer (≤cT2), including patients with IPC (cT1a/b). A follow-up examination of all patients treated with AS was carried out. Overall, cancer-specific, and metastasis-free survival and discontinuation rates were determined. Results: Of 210 IPC patients, 68 opted for AS and were available for evaluation. Fifty-four patients had cT1a category and 14 cT1b category. Median follow-up was 7.7 years (IQR: 5.7–9.1). Eight patients died of which 6 were still under AS or watchful waiting (WW). No PCa-specific death could be observed. One patient developed metastasis. Twenty-three patients (33.8%) discontinued AS changing to invasive treatment: 12 chose radical prostatectomy, 7 radiotherapy, and 4 hormonal treatment. Another 19 patients switched to WW. The Kaplan-Meier estimated 10-year overall, cancer-specific, metastasis-free, and intervention-free survival was 83.8% (95% CI: 72.2–95.3), 100%, 98.4% (95% CI: 95.3–99.9), and 61.0% (95% CI: 47.7–74.3), respectively. In multivariable analysis, age (RR: 0.97; p < 0.001), PSA density ≥0.2 ng/mL2 (RR: 13.23; p < 0.001), and PSA ≥1.0 ng/mL after surgery (RR: 5.19; p = 0.016) were significantly predictive for receiving an invasive treatment. Conclusion: In comparison with other AS series with a general low-risk prostate cancer population, our study confirmed the promising survival outcomes for IPC patients, whereas discontinuation rates seem to be lower for IPC. Thus, IPC patients at low risk of progression may be good candidates for AS.

show abstract

Section: Introductionmentioning

confidence: 99%

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Herden

Schwarte

Boedefeld³

et al. 2021

Urol Int

View full text Add to dashboard Cite

show abstract

“…The aforementioned pathologic interactions possibly include specific connexions with the low grade and most-likely indolent incidental prostate cancer (iPCa) 62 identified after HoLEP surgery. Thus, they deserve a careful extended follow up on our case-report patient both for BPH/iPCa long-term recovery and schwannomatosis indolent stability, and warrant complementary detailed biochemical and molecular biology analyses, focused primarily on HoLEP and schwannoma FFPE samples, thereby culminating possibly in new developments of the emerging exosomes/ extracellular vesicles-mediated therapeutic/prophylactic armamentarium.…”

Section: Resultsmentioning

confidence: 99%

Age-related schwannomatosis with potential exosome-mediated contribution to prostate hyperplasia: a case report and mini-review

Chignon-Sicard

Hofman

Chevallier

et al. 2019

Therapeutic Advances in Urology

View full text Add to dashboard Cite

A 72-year-old Caucasian man incurring a prostate hypertrophy presented with a right forearm nodule, the growth of which appeared to parallel the rise in his blood prostate-specific antigen (PSA) level. Echographic examination was consistent with a median-nerve schwannoma, and was confirmed upon magnetic resonance imaging (MRI). Excision of the nodule was readily performed without significant neural damage, and its schwannoma nature was confirmed upon immunohistochemistry analysis. Importantly, blood PSA dropped abruptly from ≈13 to ≈5 ng/ml within 2 months postschwannoma resection, a swift drastic reduction unachievable with oral dutasteride alone. However, 6 weeks later, a new nodule became apparent on the back of the left knee and was identified as a second schwannoma, thereby suggesting that its growth could have been stimulated by the resection of the first schwannoma, as previously described for vestibular schwannomas. The second schwannoma was in fact two: the bigger one was in the common fibular nerve and the smaller one in the tibial nerve. Both echography and MRI results were confirmed upon surgical resection of the bigger knee schwannoma. Although the third schwannoma has not yet been resected and formally characterized, we face a schwannomatosis case with an unexpected potential exosome-mediated stimulating effect on PSA secretion (PSA immunohistochemistry was negative on both schwannomas). On the other hand, preliminary genomic analysis showed a deficient balance for chromosome 22, the very chromosome carrying the three main genes involved in schwannomatosis. This age-related schwannomatosis case is thus discussed in light of the following: age-related DNA repair deficiency culminating in loss of chromosome/heterozygosity; CpG methylation/demethylation-based epigenetic aging; age-related functional decline of the immune system responsible for inefficient elimination of abnormal cells and subsequent tumorigenic cell turn-over; exosome-mediated pathologic intercellular communications; and prostate-invading brain neural progenitors as pathologic peripheral nervous system (PNS) cells.

show abstract

“…In a cohort, the rise of iPCa rate was postulated to be the results from the changes of clinical practice, and they found that the increasing iPCa rate was accompanied with a decreasing confirmation of benign biopsies prior to the surgeries of obstructive prostatic enlargement. 13 Nevertheless, the sensitivity and specificity of transrectal ultrasound guided-biopsy was around 44% and 73%, 14 respectively. Herein, even though confirming benign tissues from biopsies, urologists would still encounter iPCa.…”

Section: Discussionmentioning

confidence: 99%

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

Yang¹,

Lin²,

WC³

et al. 2022

IJGM

View full text Add to dashboard Cite

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.

show abstract

Temporal Trend in Incidental Prostate Cancer Detection at Surgery for Benign Prostatic Hyperplasia

Abstract: The increased rate of low-risk PCa detected after BPH surgery in the last decade reflects the clinical practice changes in PCa screening and diagnosis leading to a reduced number of unnecessary biopsies and indolent cancer diagnosis.

Cited by 44 publications

References 23 publications

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Age-related schwannomatosis with potential exosome-mediated contribution to prostate hyperplasia: a case report and mini-review

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

Contact Info

Product

Resources

About