To assess changes in the rate of incidental PCa after BPH surgery over the last decade.
We identified 1,177 patients surgically treated for BPH (open prostatectomy, trans-urethral resection or holmium laser enucleation (HoLEP) of the prostate) in 2007-2016 at a single European academic center. Local polynomial regression was used to explore changes in the rate of incidental PCa detected after BPH surgery and of pre-operative biopsy performed over time. Logistic regression analyses tested the association of incidental PCa diagnosis with year of surgery and pre-operative biopsy.
Incidental PCa was found in 6.4% (74) of cases, 67 (91%) with Grade group 1 disease. We observed an increased incidence of PCa diagnosis after BPH surgery over time (OR: 1.12; 95%CI: 1.02 - 1.24, p=0.02) along with a concomitant decrease in the rate of pre-operative prostate biopsies (OR: 0.83; 95%CI: 0.79 - 0.88, p<0.0001). Patients undergoing a pre-operative biopsy showed a lower risk of being diagnosed with PCa after surgery (OR: 0.29; 95% CI: 0.12, 0.72 p=0.007). Patients treated with HoLEP had a higher chance of incidental PCa detection (OR: 2.28; 95%CI: 1.30 - 4.00; p=0.004), although this may be related to the significantly higher number of HoLEP performed over the last years.
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.
Urology. 2018 Aug 20 [Epub ahead of print]
Paolo Capogrosso, Umberto Capitanio, Emily A Vertosick, Eugenio Ventimiglia, Francesco Chierigo, Davide Oreggia, Donatella Moretti, Alberto Briganti, Andrew J Vickers, Francesco Montorsi, Andrea Salonia
Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: ., Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy., Memorial Sloan Kettering Cancer Center, New York, NY, USA., Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.