Objective: To determine the incidence of prostate cancer identified on holmium enucleation of the prostate (HoLEP) specimens and evaluate variables associated with prostate cancer identification.
Methods: All patients undergoing HoLEP by a single surgeon between 1998 and 2013 were identified. Patients with a known history of prostate cancer were excluded. Multivariable logistic regression assessed variables associated with identification of prostate cancer on HoLEP specimens and Gleason 7 or higher prostate cancer among the malignant cases. Gleason grade was used as a proxy for disease severity. Each of the models was adjusted for age, preoperative PSA, and HoLEP specimen weight.
Results: The cohort was comprised of 1272 patients of whom 103 (8.1%) had prostate cancer identified. Prostate cancer cases had higher pre-HoLEP PSA (p=0.06) but lower HoLEP specimen weight (p=0.01). On multivariate logistic regression, age and preoperative PSA weight were associated with increased odds of prostate cancer being present (p< 0.01 each) while increasing HoLEP specimen weight was associated with decreased odds of prostate cancer (p< 0.001). Men older than 80 had 20% predicted probability of being diagnosed with prostate cancer. Seventy-eight percent of prostate cancer cases were Gleason 6 or less. Pre-HoLEP PSA was associated with increased adjusted odds of intermediate or high grade prostate cancer.
Conclusion: Prostate cancer identified by HoLEP is not uncommon but is generally low risk disease. Older patients with smaller prostate glands have the highest odds of prostate cancer identification.
Written by:
Bhojani N, Boris RS, Monn MF, Mandeville JA, Lingeman JE. Are you the author?
Centre Hospitalier de l'Universite de Montreal, Urology, Montreal, Quebec, Canada.
Reference: J Endourol. 2014 Jul 21. Epub ahead of print.
doi: 10.1089/end.2014.0359
PubMed Abstract
PMID: 25046691
