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Gloger S, Paulics L, Philippou C, Philippou S, Witt JH, Ubrig B. Perioperative Rates of Incidental Prostate Cancer after Aquablation and Holmium Laser Enucleation of the Prostate. Urol Int 2024:1-8. [PMID: 38801817 DOI: 10.1159/000539014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/03/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Aquablation and holmium laser enucleation of the prostate (HoLEP) have evolved as established therapeutic options for men with benign prostatic obstruction (BPO). We sought to compare the rates of incidental prostate cancer (iPCa) after aquablation and HoLEP. METHODS At our center, between January 2020 and November 2022, 317 men underwent aquablation, and 979 men underwent HoLEP for BPO. Histopathological assessment of resected tissue was conducted in all cases. If iPCa was detected, the Gleason score and percentage of affected tissue were assessed. Differences in important predictive factors for prostate cancer between study groups were accounted for by additional matched pairs analysis (with matching on age ± 1 year; PSA ± 0.5 ng/mL; and prostate volume ± 5 mL). RESULTS Histopathology revealed iPCas in 60 patients (4.6%): 59 (6.03%) after HoLEP and 1 (0.3%) after aquablation (p = 0.001). Of 60 of incidental cancers, 11 had a Gleason score ≥7 (aquablation: 1/1 [100%]; HoLEP: 10/59 [16.9%]). The aquablation and HoLEP study groups differed in patient age, preoperative PSA, and prostate volume. Therefore, matched pairs analysis (aquablation: 132 patients; HoLEP: 132 patients) was conducted to improve comparability. Also after the matching procedure, significantly fewer iPCas were diagnosed after aquablation than HoLEP (aquablation: 0 [0%]; HoLEP: 6 [4.5%]; p = 0.015). CONCLUSION Significantly fewer iPCas were identified after aquablation than HoLEP procedures. Histopathologic assessment of tissue after aquablation is feasible and may lead to the diagnosis of clinically significant iPCa. Therefore, histopathologic examination of the aquablation resective tissue should not be omitted.
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Affiliation(s)
- Simon Gloger
- Center for Minimally Invasive and Robotic Urology, Augusta Hospital Bochum, Witten/Herdecke University, Bochum, Germany
| | - Laszlo Paulics
- Center for Minimally Invasive and Robotic Urology, Augusta Hospital Bochum, Witten/Herdecke University, Bochum, Germany
| | - Christos Philippou
- Institute for Pathology and Cytology, Augusta Hospital Bochum, Bochum, Germany
| | - Stathis Philippou
- Institute for Pathology and Cytology, Augusta Hospital Bochum, Bochum, Germany
| | - Joern H Witt
- Department of Urology, Goldstadt Privatklinik, Pforzheim, Germany
| | - Burkhard Ubrig
- Center for Minimally Invasive and Robotic Urology, Augusta Hospital Bochum, Witten/Herdecke University, Bochum, Germany
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Kimura S, Katayama H, Ohara E, Aoki H, Shibuya R, Naganuma H, Ishidoya S, Ito A. Prostate-specific antigen follow-up and management for patients undergoing holmium laser enucleation of the prostate. Int J Urol 2024; 31:82-87. [PMID: 37803911 DOI: 10.1111/iju.15315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To investigate who needs a careful postoperative monitoring for prostate cancer (PCa) after holmium laser enucleation of the prostate (HoLEP). We examined characteristics and oncological outcomes of HoLEP-related PCa. METHODS Patients who underwent HoLEP during 2002-2017 in a Japanese tertiary center were retrospectively analyzed. Patients were divided into non-PCa, PCa with HoLEP specimen (PCa-Ope), and PCa diagnosed during follow-up (PCa-Post). Outcomes of all HoLEP-related PCa were monitored. RESULTS Of the total 758, 60 (7.9%) were diagnosed with PCa from resected specimen of HoLEP and 9 (1.2%) were diagnosed postoperatively. Preoperative prostate-specific antigen (iPSA), postoperative PSA (pPSA), and PSA density were significantly higher in both PCa groups than those in non-PCa group. While iPSA significantly correlated to prostate volume (PV), pPSA was not associated with PV. A receiver-operating-characteristics curve demonstrated that pPSA 1.2 ng/mL achieved the optimal cut-off (AUC 0.95) for the incidence of PCa-Post. In addition to the incidence of PCa and iPSA, lower enucleation efficiency (enucleated volume /PV) was significantly associated with pPSA >1.2 ng/mL. Among PCa-Ope, 51 were Grade Group (GG) ≤2 and 42 were followed-up with active surveillance, whereas 8 of 9 PCa-Post were GG ≥3 and 2 progressed to death. CONCLUSIONS Patients undergoing HoLEP are associated with some risk of potential PCa. While oncological outcomes were favorable among PCa-Ope, postoperative PSA should be carefully monitored even if not diagnosed with PCa with HoLEP specimen. Enucleation efficiency should be also considered not to misread pPSA value.
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Affiliation(s)
- Shingo Kimura
- Department of Urology, Sendai City Hospital, Sendai, Japan
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiromichi Katayama
- Department of Urology, Sendai City Hospital, Sendai, Japan
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eiichiro Ohara
- Department of Urology, Sendai City Hospital, Sendai, Japan
| | - Hiroshi Aoki
- Department of Urology, Sendai City Hospital, Sendai, Japan
| | - Rie Shibuya
- Department of Pathology, Sendai City Hospital, Sendai, Japan
| | | | | | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Banno T, Nakamura K, Ozaki A, Kouchi Y, Ohira T, Shimmura H. Robot-assisted radical prostatectomy following holmium laser enucleation of the prostate: perioperative, functional, and oncological outcomes. J Robot Surg 2023; 17:2125-2133. [PMID: 37247118 DOI: 10.1007/s11701-023-01621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023]
Abstract
Robot-assisted radical prostatectomy with previous holmium laser enucleation of the prostate is challenging, and few studies have analyzed its perioperative, functional, and oncological outcomes. Here we retrospectively evaluated 298 robot-assisted radical prostatectomies, including 25 with and 273 without previous holmium laser enucleation of the prostate, performed in 2015-2022. Regarding perioperative outcomes, operative and console times were significantly longer in the previous holmium laser enucleation of the prostate group. In contrast, the estimated blood loss was similar between groups, and there were no transfusions or intraoperative complications. Multivariable Cox hazard regression analysis of the functional outcomes of postoperative urinary continence showed that body mass index, intraoperative bladder neck repair, and nerve sparing were independently associated factors, whereas a history of holmium laser enucleation of the prostate was not. Similarly, a history of holmium laser enucleation of the prostate was not associated with biochemical recurrence; however, positive surgical margins and seminal vesicle invasion were independent risk factors of biochemical recurrence. Our findings revealed that robot-assisted radical prostatectomy after holmium laser enucleation of the prostate was safe and raised no concerns of postoperative urinary incontinence or biochemical recurrence. Therefore, robot-assisted radical prostatectomy may be a treatment option for patients with prostate cancer after holmium laser enucleation of the prostate.
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Affiliation(s)
- Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan.
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa foundation, Iwaki, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan
| | | | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan
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Banno T, Nakamura K, Ozaki A, Kouchi Y, Ohira T, Shimmura H. A Propensity Score-Matched Analysis of Perioperative Outcomes of Holmium Laser Enucleation of the Prostate Between Lumenis Pulse 120H and VersaPulse Select 80W. J Endourol 2023; 37:1043-1048. [PMID: 37427433 DOI: 10.1089/end.2022.0804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Objectives: Holmium laser enucleation of the prostate (HoLEP) is a valid and safe procedure for the treatment of benign prostatic hyperplasia. This study aimed to examine the perioperative outcomes of HoLEP using a new laser platform, Lumenis Pulse™ 120H, and a previous laser platform, VersaPulse Select 80W. Methods: A total of 612 patients who underwent holmium laser enucleation were enrolled, including 188 and 424 patients who underwent enucleation using Lumenis Pulse 120H and VersaPulse Select 80W, respectively. They were matched using propensity scores with preoperative patient characteristics, and the differences between the two groups, including operative time, enucleated specimen, transfusion rate, and complication rate, were examined. Results: Propensity score-matched cohort comprised 364 patients with 182 in the Lumenis Pulse 120H group (50.0%) and 182 in the VersaPulse Select 80W group (50.0%). Operative time was significantly shorter with Lumenis Pulse 120H (55.2 ± 34.4 vs 101.4 ± 54.3 minutes, p < 0.001). In contrast, no significant differences were seen in resected specimen weight (43.8 ± 29.8 vs 39.6 ± 22.6 g, p = 0.36), rate of incidental prostate cancer (7.7% vs 10.4%, p = 0.36), transfusion rate (0.6% vs 1.1%, p = 0.56), and perioperative complication rates, including urinary tract infection, hematuria, urinary retention, and capsular perforation (5.0% vs 5.0%, 4.4% vs 2.7%, 0.5% vs 4.4%, 0.5% vs 0%, respectively, p = 0.13). Conclusions: Lumenis Pulse 120H improved the operative time significantly, which is regarded as one of the disadvantages of HoLEP.
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Affiliation(s)
- Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
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Guo Z, He J, Huang L, Wang Z, Hu P, Wang S, Bai Z, Pan J. Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis. Int Braz J Urol 2022; 48:915-929. [PMID: 35195386 PMCID: PMC9747035 DOI: 10.1590/s1677-5538.ibju.2021.0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to explore the prevalence and clinical risk factors in patients diagnosed with incidental prostate cancer (IPC) during certain surgeries (transurethral resection of the prostate [TURP], open prostatectomy [OP], and holmium laser enucleation of the prostate [HoLEP]) after clinically suspected benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Literature search of the MEDILINE, Web of Science, Embase, and Cochrane Library databases was performed to identify eligible studies published before June 2021. Multivariate adjusted odds ratios (ORs) and associated 95% confidence intervals (CIs) of the prevalence and clinical risk factors of IPC were calculated using random or fixed-effect models. RESULTS Twenty-three studies were included in the meta-analysis. Amongst the 94.783 patients, IPC was detected in 24.715 (26.1%). Results showed that the chance of IPC detection (10%, 95% CI: 0.07-4.00; P<0.001; I2=97%) in patients treated with TURP is similar to that of patients treated with HoLEP (9%, 95% CI: 0.07-0.11; P<0.001; I2=81.4%). However, the pooled prevalence estimate of patients treated with OP was 11% (95% CI: -0.03-0.25; P=0.113; I2=99.1%) with no statistical significance. We observed increased incidence of IPC diagnosis after BPH surgery amongst patients with higher prostate-specific antigen (PSA) level (OR: 1.13, 95% CI: 1.04-1.23; P=0.004; I2=89%), whereas no effect of age (OR: 1.02, 95% CI: 0.97-1.06; P=0.48; I2=78.8%) and prostate volume (OR: 0.99, 95% CI: 0.96-1.03; P=0.686; I2=80.5%) were observed. CONCLUSIONS The prevalence of IPC was similar amongst patients undergoing TURP, HoLEP, and OP for presumed BPH. Interestingly, increased PSA level was the only independent predictor of increasing risk of IPC after BPH surgery rather than age and prostate volume. Hence, future research should focus on predictors which accurately foretell the progression of prostate cancer to determine the optimal treatment for managing patients with IPC after BPH surgery.
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Affiliation(s)
- Zhenlang Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of UrologyGuangzhouChinaDepartment of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junwei He
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of UrologyGuangzhouChinaDepartment of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lijuan Huang
- The First Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Organ TransplantGuangzhouChinaDepartment of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhaohui Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of UrologyGuangzhouChinaDepartment of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ping Hu
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of UrologyGuangzhouChinaDepartment of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shusheng Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of UrologyGuangzhouChinaDepartment of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zunguang Bai
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of UrologyGuangzhouChinaDepartment of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese MedicineDepartment of UrologyGuangzhouChinaDepartment of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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The significance of the extent of tissue embedding for the detection of incidental prostate carcinoma on transurethral prostate resection material: the more, the better? Virchows Arch 2022; 481:387-396. [PMID: 35710851 PMCID: PMC9485088 DOI: 10.1007/s00428-022-03331-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022]
Abstract
The aim of this study is to investigate the incidental prostate cancer (iPCa) detection rates of different embedding methods in a large, contemporary cohort of patients with bladder outlet obstruction (BOO) treated with transurethral surgery. We relied on an institutional tertiary-care database to identify BOO patients who underwent either transurethral loop resection or laser (Holmium:yttrium–aluminium garnet) enucleation of the prostate (HoLEP) between 01/2012 and 12/2019. Embedding methods differed with regard to the extent of the additional prostate tissue submitted following the first ten cassettes of primary embedding (cohort A: one [additional] cassette/10 g residual tissue vs. cohort B: complete embedding of the residual tissue). Detection rates of iPCa among the different embedding methods were compared. Subsequently, subgroup analyses by embedding protocol were repeated in HoLEP-treated patients only. In the overall cohort, the iPCa detection rate was 11% (46/420). In cohort A (n = 299), tissue embedding resulted in a median of 8 cassettes/patient (range 1–38) vs. a median of 15 (range 2–74) in cohort B (n = 121) (p < .001). The iPCa detection rate was 8% (23/299) and 19% (23/121) in cohort A vs. cohort B, respectively (p < .001). Virtual reduction of the number of tissue cassettes to ten cassettes resulted in a iPCa detection rate of 96% in both cohorts, missing one stage T1a/ISUP grade 1 carcinoma. Increasing the number of cassettes by two and eight cassettes, respectively, resulted in a detection rate of 100% in both cohorts without revealing high-grade carcinomas. Subgroup analyses in HoLEP patients confirmed these findings, demonstrated by a 100 vs. 96% iPCa detection rate following examination of the first ten cassettes, missing one case of T1a/ISUP 1. Examination of 8 additional cassettes resulted in a 100% detection rate. The extent of embedding of material obtained from transurethral prostate resection correlates with the iPCa detection rate. However, the submission of 10 cassettes appears to be a reasonable threshold to reduce resource utilization while maintaining secure cancer detection.
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Banno T, Nakamura K, Kaneda Y, Ozaki A, Kouchi Y, Ohira T, Shimmura H. Detection rate and variables associated with incidental prostate cancer by holmium laser enucleation of the prostate. Int J Urol 2022; 29:860-865. [PMID: 35584916 DOI: 10.1111/iju.14917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/17/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Holmium laser enucleation of the prostate is well-established and effective for bladder outlet obstruction due to benign prostatic hyperplasia. The objective of this study was to examine the detection rate of incidental prostate cancer by holmium laser enucleation of the prostate and variables associated with them. METHODS A total of 612 patients were enrolled. We retrospectively examined the detection rate of incidental prostate cancer and perioperative variables associated with them. RESULTS Forty-nine of 612 patients were diagnosed with incidental prostate cancer. Univariate logistic regression analysis showed that higher prostate-specific antigen density (odds ratio 3.34, 95% confidence interval 1.02-10.94, P = 0.05), higher prostate-specific antigen density of the transition zone (odds ratio 2.28, 95% confidence interval 1.02-5.09, P = 0.04), and findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.71, 95% confidence interval 1.70-13.1, P = 0.003; transition zone: odds ratio 3.46, 95% confidence interval 1.74-6.86, P < 0.001; peripheral and transition zones: odds ratio 6.00, 95% confidence interval 1.51-23.8, P = 0.01) were significantly associated with incidental prostate cancer. Multivariate logistic regression analysis showed that findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.36, 95% confidence interval 1.49-12.8, P = 0.001; transition zone: odds ratio 3.54, 95% confidence interval 1.75-7.16, P < 0.001; peripheral and transition zones: odds ratio 6.14, 95% confidence interval 1.53-24.5, P = 0.01) was an independent risk factor for incidental prostate cancer. CONCLUSION The detection rate of incidental prostate cancer was 8.0%, and findings of the prostate cancer on magnetic resonance imaging were an independent predictive factor for incidental prostate cancer.
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Affiliation(s)
- Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
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Yilmaz M, Toprak T, Suarez-Ibarrola R, Sigle A, Gratzke C, Miernik A. Incidental prostate cancer after holmium laser enucleation of the prostate-A narrative review. Andrologia 2021; 54:e14332. [PMID: 34837229 DOI: 10.1111/and.14332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/05/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer can be detected incidentally after surgical therapy for benign prostatic obstruction such as holmium laser enucleation of the prostate (HoLEP), thus called incidental prostate cancer (iPCa). We aimed to review the studies on iPCa detected after HoLEP and investigate its prevalence. A detailed search of original articles was conducted via the PubMed-MEDLINE, Web of Science, Wiley Online Library and Cochrane Library databases in the last 10 years up to 1 May 2021 with the following search string solely or in combination: "prostate cancer", "prostate carcinoma", "holmium laser enucleation of the prostate" and "HoLEP". We identified 19 articles to include in our analysis and divided them into six main categories: HoLEP versus open prostatectomy and/or transurethral resection of the prostate in terms of iPCa, oncological and functional outcomes, the role of imaging modalities in detecting iPCa, predictive factors of iPCa, the role of prostate-specific antigen kinetics in detecting iPCa and the management of iPCa after HoLEP. We found that the iPCa after HoLEP rate ranges from 5.64% to 23.3%. Functional and oncological outcomes were reported to be encouraging. Oncological treatment options are available in a wide range.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
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Cheng BKC, Castellani D, Chan ISH, Baker A, Gauhar V, Wroclawski ML, Santamaria HT, Tanidir Y, Enikeev D, Chan VWS, Ng CF, Herrmann T, Teoh JYC. Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol 2021; 40:87-101. [PMID: 34142230 DOI: 10.1007/s00345-021-03756-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/05/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION This systematic review aims at reporting the incidence, predictive factors, and the oncological outcomes of incidental prostate cancer (IPCa) in men who underwent endoscopic enucleation of prostate (EEP). METHODS A literature search was performed using the following Medical Subject Heading (MeSH) terms and keywords: "Prostatic Neoplasms", "Prostate Cancer", "Transurethral Resection of Prostate", "Prostate resection", "Prostate enucleation". Meta-analysis was performed if there were two or more studies reporting the same outcome under the same definition. In case of insufficient data, results were presented in a narrative manner. RESULTS Sixty-one studies were included in qualitative synthesis and 55 were included in meta-analysis. The pooled IPCa rate was 0.08 (95% CI 0.073-0.088). Increasing age, higher preoperative serum prostate-specific antigen (PSA) level, higher preoperative PSA density (PSAD), smaller prostate volume, higher postoperative PSA velocity and lower enucleated prostate weight, were reported to have significant correlation with IPCa. In BPH patients, the mean pre-operative and post-operative PSA levels were 5.58 ± 1.48 ng/dL and 1.06 ± 0.27 ng/dL, respectively. In patients with IPCa, the mean pre-operative and post-operative PSA levels were 7.72 ± 2.90 ng/dL and 2.77 ± 1.66 ng/dL, respectively. The mean percentage PSA reduction was 82.0% ± 1.8% for BPH patients and 68.2% ± 12.1% for IPCa patients. IPCa was most commonly managed by active surveillance (68.7%). CONCLUSIONS The pooled incidence of IPCa after EEP was 8%. An absolute post-operative PSA level of < 2.0 and a percentage PSA reduction of > 70% should be expected in BPH patients after EEP.
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Affiliation(s)
| | - Daniele Castellani
- Department of Urology, University Hospital "Ospedali Riuniti" and Polytechnic University of Marche Region, Ancona, Italy
| | - Ivan Sik-Hei Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Abu Baker
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Jurong East, Singapore
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- BP-a Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, İstanbul, Turkey
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vinson Wai-Shun Chan
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Department of Urology, Hanover Medical School (MHH), Hanover, Germany
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
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Magistro G, Keller P, Westhofen T, Schott M, Tamalunas A, Weinhold P, Stief CG. The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates. World J Urol 2021; 39:1481-1487. [PMID: 32588205 DOI: 10.1007/s00345-020-03321-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/16/2020] [Indexed: 02/12/2023] Open
Abstract
PURPOSE To evaluate the diagnostic value of a high preoperative PSA level for the detection of incidental prostate cancer (iPCa) in LUTS patients with very large prostates (> 100 cc). METHODS We conducted a retrospective analysis of 1125 men treated for LUTS with holmium laser enucleation of the prostate (HoLEP). Patients were stratified according to a preoperative PSA level higher (high PSA; n = 365) or lower than 10 ng/ml (low PSA; n = 760). Preoperative and histopathological parameters were compared between both cohorts. Logistic regression models were used to identify independent predictors of iPCa. RESULTS Demographic parameters were similar between both cohorts. The median PSA levels were 14.2 ng/ml (11.5-19.9) and 4 ng/ml (2.4-6.0). The prostate volume was significantly higher in the high PSA group (105 cc vs. 75 cc; p < 0.001). Correspondingly, the PSA density was significantly increased in the high PSA cohort compared to the low PSA cohort (0.14 vs. 0.05; p < 0.001). The overall detection rate of iPCa showed no difference between groups (9.5% vs. 9.9%). More preoperative prostate biopsies were performed in the high PSA group compared to the low PSA group (46.8% vs. 17.6%; p < 0.001). However, the rate of false negative results was comparable between groups (12.7% vs. 11.1%; p = 0.726). In logistic regression models all PSA-related parameters failed to predict iPCa. CONCLUSIONS PSA-guided approaches to predict iPCa in LUTS patients with very large prostates are not accurate. This finding is useful in clinical practice for counselling our patients and to prevent unwarranted diagnostic procedures.
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Affiliation(s)
- Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Patrick Keller
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thilo Westhofen
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Melanie Schott
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Tamalunas
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
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11
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Yıldız A, Akdemir S, Anıl H, Arslan M. Safety and Efficacy of High-Powered Holmium Laser Enucleation of the Prostate within 1-3 Weeks Following Prostate Biopsy. Urol Int 2021; 105:852-857. [PMID: 33780959 DOI: 10.1159/000514422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We aim to document the feasibility, perioperative safety, and the 12-month efficacy of holmium laser enucleation of the prostate (HoLEP) within 1-3 weeks following transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS Data of the patients who underwent HoLEP following TRUS-guided prostate biopsy between March 2017 and July 2020 were analyzed retrospectively. Patients were divided into 2 groups: group 1 had undergone HoLEP in the early period after TRUS-guided prostate biopsy, while group 2 patients were biopsy-naive ("control group"). All patients were assessed preoperatively by a physical examination with the digital rectal examination; time from biopsy to HoLEP; measurement of Qmax, postvoiding residual volume, and prostate volume by transabdominal ultrasonography; serum prostate-specific antigen level, the International Prostate Symptom Score (IPSS); the International Index of Erectile Function-5 questionnaire; and urine analysis. The patients were reevaluated at 3- and 12-month follow-up. Perioperative and postoperative complications were documented according to the modified Clavien-Dindo System. RESULTS Group 1 comprised 66 patients with a mean age of 67.3 ± 6.7 (range, 53-86) years, and group 2 comprised 114 patients with a mean age of 69.4 ± 9.4 (range, 36-95) years. The operation, enucleation, and morcellation efficiencies were not statistically significant between the groups. Preoperative Qmax and IPSS values were significantly improved after HoLEP surgery in the 3rd and 12th months in all patients. Our complication rates were similar in both groups. CONCLUSION High-powered HoLEP using 140 W energy within 1-3 weeks following TRUS-guided prostate biopsy is a feasible procedure with high enucleation efficiency, low perioperative morbidity, and excellent functional outcomes. A recent TRUS-guided prostate biopsy is not a contraindication to HoLEP.
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Affiliation(s)
- Ali Yıldız
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
| | - Serkan Akdemir
- Department of Urology, Private Tinaztepe Hospital, Izmir, Turkey
| | - Hakan Anıl
- Department of Urology, Adana City Training and Research Hospital, Adana, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
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12
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Etafy MH, Katz JE, Gonzalgo MR, Garcia Lopez EA, Shah RH, Banerjee I, Smith N, Shah HN. Holmium Laser Enucleation of Prostate Within 6 Weeks of Transrectal Ultrasound Guided Prostate Biopsy is Safe and Effective. Urology 2020; 148:88-92. [PMID: 33227302 DOI: 10.1016/j.urology.2020.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of performing Holmium laser enucleation of the prostate (HoLEP) for the treatment of bladder outlet obstruction secondary to an enlarged prostate within 6-weeks of a transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS We performed a retrospective review of patients who underwent a HoLEP at our institution, excluding any patients with a confounding urologic history and compared patients who underwent a TRUS-guided 6- or 12-core prostate biopsy, and then underwent a HoLEP within 6 weeks (study group) with all other patients (control group). Our primary outcomes were enucleation efficiency (EE) and perioperative complication rate. Our secondary outcomes included postoperative drop in hemoglobin, duration of catheterization, length of hospital stay, voiding metrics at 1 and 6 months and rate of incidental prostate cancer diagnosed on histopathological examination of prostate specimens after HoLEP. To test for differences between the study and control groups, we performed independent sample t-test (2-tailed) and chi-square tests for quantitative and qualitative variables, respectively. P values of < 0.05 were considered statistically significant. RESULTS 552 patients met inclusion criteria and 84 patients underwent prostate biopsy within a period of 45 days prior to HoLEP. Enucleation efficiency was higher in the study group (P = 0.00). There was no significant difference between the 2 groups regarding perioperative complications, postoperative voiding outcomes, or rate of incidental prostate cancer detection. CONCLUSIONS TRUS prostate biopsy performed within 6 weeks of HoLEP does not negatively impact operative difficulty or treatment outcome.
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Affiliation(s)
| | | | - Mia R Gonzalgo
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Rashmi H Shah
- S. L. Raheja (Fortis Associate Hospital), Mumbai, India
| | | | - Nicholas Smith
- Miller School of Medicine, University of Miami, Miami, FL
| | - Hemendra N Shah
- Miller School of Medicine, University of Miami, Miami, FL; S. L. Raheja (Fortis Associate Hospital), Mumbai, India.
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13
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Management of prostate cancer after holmium laser enucleation of the prostate. Urol Oncol 2020; 39:297.e1-297.e8. [PMID: 33221258 DOI: 10.1016/j.urolonc.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) is effective in treating lower urinary tract symptoms from prostatic disease. We investigate the role of HoLEP in the management of patients with benign prostatic hypertrophy (BPH) and prostate cancer (CaP). METHODS Retrospective review of data regarding all patients undergoing HoLEP at a single institution was performed. Pre- and postoperative PSA, multiparametric MRI, and pathology results were analyzed for those with CaP identified prior to or incidentally at HoLEP. RESULTS From February 2016 to February 2020, 201 patients underwent HoLEP. Twelve patients had CaP diagnosed before HoLEP: 6 patients with GG1 are on active surveillance (AS), 3 of 4 intermediate-risk patients are on AS and 1 received treatment for disease progression, and both high-risk CaP patients achieved symptomatic benefit from HoLEP and are receiving systemic therapy for CaP. Twenty-one patients (11.1%) with incidentally detected CaP at HoLEP remain on AS or watchful waiting based on clinical scenario. CONCLUSION Screening for CaP in HoLEP candidates with PSA and MRI is recommended given that >10% will have incidental CaP. After HoLEP for BPH/LUTS, patients with CaP can be surveilled with PSA and/or MRI. Further investigation is warranted to determine the durability of success of these approaches.
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14
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He G, Sun C, Shu Y, Wang B, Du C, Chen J, Wen J. The diagnostic value of prostate cancer between holmium laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia: A retrospective comparative study. Int J Surg 2020; 79:217-221. [PMID: 32447004 DOI: 10.1016/j.ijsu.2020.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/09/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the diagnostic value of prostate cancer (PCa) between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP). METHODS We retrospectively analyzed the clinical data of 2909 patients who underwent surgery for benign prostatic hyperplasia (BPH) from January 2008 to June 2018. A total of 1362 patients received HoLEP, and 1547 patients received TURP. The baseline patient characteristics were collected. We then compared the perioperative outcomes of these patients who diagnosed with incidentally diagnosed prostatic carcinoma (IDPC) or PCa after BPH surgeries. RESULTS The total detection rate of PCa in HoLEP group was higher than that in TURP group (85/6.24% vs. 61/3.94%, p = 0.005). Specifically, 55(4.6%) patients were diagnosed with IDPC in HoLEP group with prostate-specific antigen (PSA) less than 4 ng/ml, and 37(2.7%) patients in TURP group (p = 0.014). For the patients with PSA between 4 and 10 ng/ml, 15(13.9%) patients were diagnosed with PCa after HoLEP, and 6(5.0%) patients after TURP (p = 0.023). But the detection rate of PCa was not significantly different between the two groups when PSA was over 10 ng/ml. On the other hand, 57 in 1215 patients with no prostate biopsy preoperatively were diagnosed with PCa after HoLEP, while 42 in 1370 patients after TURP (4.7% vs. 3.1%, p = 0.040), respectively. Twenty-six patients received once biopsy and diagnosed with PCa in HoLEP group, while 15 patients in TURP group (18.4% vs. 8.9%, p = 0.018), respectively. However, no significant difference was observed for patients who received twice prostate biopsy in the two groups. CONCLUSIONS The present study showed that HoLEP can provide a higher total detection rate of PCa when compared with TURP. Besides, this superiority was especially embodied in patients with PSA less than 10 ng/ml.
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Affiliation(s)
- Gaofei He
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chengfang Sun
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuanyuan Shu
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bohan Wang
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chuanjun Du
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jimin Chen
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaming Wen
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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15
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Bell C, Moore SL, Gill A, Obi-Njoku O, Hughes SF, Saleemi A, Ellis G, Khan F, Shergill IS. Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study. BMC Urol 2019; 19:97. [PMID: 31640663 PMCID: PMC6805368 DOI: 10.1186/s12894-019-0523-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB). Methods Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 (n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 (n = 85). The primary outcome was successful HoLEP. Results There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 (p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups. Conclusions In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.
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Affiliation(s)
- Chris Bell
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK. .,North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Sacha L Moore
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Amarit Gill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK.,North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Obinna Obi-Njoku
- North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Stephen F Hughes
- North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Asad Saleemi
- Department of Urology, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - Gidon Ellis
- Department of Urology, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - Farooq Khan
- Department of Urology, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - Iqbal S Shergill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK.,North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
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16
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Tominaga Y, Sadahira T, Mitsui Y, Maruyama Y, Tanimoto R, Wada K, Munemasa S, Kusaka N, Nishiyama Y, Kurashige T, Nasu Y, Hayata S. Favorable long-term oncological and urinary outcomes of incidental prostate cancer following holmium laser enucleation of the prostate. Mol Clin Oncol 2019; 10:605-609. [PMID: 31031975 DOI: 10.3892/mco.2019.1839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/14/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to investigate the impact of incidental prostate cancer (IPCa), which was diagnosed by holmium laser enucleation of the prostate (HoLEP), on long-term oncological and functional outcomes. A total of 482 patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between 2008 and 2016 at our institution were retrospectively reviewed. We defined IPCa as prostate cancer (PCa) according to the enucleated tissue of transitional zone. Therefore, 64 patients were excluded for the following reasons: Prostate-specific antigen (PSA) ≥4.0 ng/ml and no prostate biopsy (n=46); and PSA ≥4.0 ng/ml and diagnosed with PCa by prostate biopsy performed during HoLEP (n=18). Notably, 418 patients were included in the study and divided into two groups: The BPH group and the IPCa group. For 5 years, postoperative PSA and functional outcomes were evaluated. Of 418 patients, 25 (6%) were diagnosed with IPCa by HoLEP, 21 patients (84%) had a Gleason score ≤6 and 5 patients (20%) received adjuvant therapy for PCa following HoLEP. No significant differences were observed between groups for preoperative PSA, PSA density, or urinary and sexual function outcomes; however, age at the time of HoLEP significantly differed between groups (71.7 vs. 75.5 years, P=0.026). Long-term (5-year) urinary outcomes demonstrated sustained improvement. Postoperative PSA increased gradually in the IPCa group (3-year, P=0.033; 4-year, P=0.037); International Index of Erectile Function 5 conversely decreased (5-year, P=0.068). According to the present results, if standard PSA screening and prostate biopsy are performed, watchful waiting for IPCa is feasible, and IPCa does not impact on 5-year urinary outcomes.
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Affiliation(s)
- Yusuke Tominaga
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Yosuke Mitsui
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Ryuta Tanimoto
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Koichiro Wada
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Shuhei Munemasa
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
| | - Nobuyuki Kusaka
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
| | - Yasuhiro Nishiyama
- Department of Urology, Kochi Health Sciences Center, Kochi, Kochi 781-8555, Japan
| | - Takushi Kurashige
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Shunji Hayata
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
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17
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Kim KH, Kim SW, Son HS, Kim DK, Jung DC, Kim HW, Kim JC, Hong SJ, Kim JH. Role of Holmium laser enucleation of the prostate to increase cancer detection rate in patients with gray-zone PSA level. MINERVA UROL NEFROL 2018; 71:72-78. [PMID: 30037211 DOI: 10.23736/s0393-2249.18.03186-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Even though the safety of the treatment for prostate cancer diagnosed by HoLEP has been reported, the diagnostic value of HoLEP for prostate cancer detection has not been confirmed. Therefore, we investigated the diagnostic potential of HoLEP for detecting prostate cancer. METHODS Between December 2009 and October 2015, 359 patients (median age, 70.9 years; range, 66.2-74.8) were treated simultaneously with HoLEP and transrectal prostate needle biopsy (TPNB). Of these, 199 patients with a normal digital rectal examination and serum PSA concentration between 3.5 and 10.0 ng/mL were included in the study. Univariate and multivariate logistic regression analyses were performed to identify the predictive factor for prostate cancer detected by HoLEP. RESULTS Median PSA, prostate volume and PSA density were 4.97 ng/mL (range, 4.20-6.70), 57.40 gm (range, 43.67-77.80) and 0.09 ng/mL2 (range, 0.07-0.12), respectively. Prostate cancer (Gleason score ≥6) was detected in 46 cases (23.1%). Of these, 26 (56.5%) were detected by HoLEP pathology, 11 (23.9%) by TPNB pathology, and 9 (19.6%) by both. Univariate and multivariate logistic regression analyses were performed in 179 patients, including benign prostatic hyperplasia patients (N=153, 76.9%) and patients with cancer detected by HoLEP pathology. PSA density was identified as an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA. CONCLUSIONS HoLEP is a viable modality for detecting prostate cancer in selected cases. PSA density was an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA.
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Affiliation(s)
- Ki H Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, South Korea
| | - Sang W Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee S Son
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae K Kim
- Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, South Korea
| | - Dae C Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun W Kim
- Department of Urology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon C Kim
- Department of Urology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, South Korea
| | - Sung J Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jang H Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea -
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18
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HoLEP provides a higher prostate cancer detection rate compared to bipolar TURP: a matched-pair analysis. World J Urol 2018; 36:2035-2041. [DOI: 10.1007/s00345-018-2353-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022] Open
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19
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Ohwaki K, Endo F, Shimbo M, Fujisaki A, Hattori K. Comorbidities as predictors of incidental prostate cancer after Holmium laser enucleation of the prostate: diabetes and high-risk cancer. Aging Male 2017; 20:257-260. [PMID: 28332895 DOI: 10.1080/13685538.2017.1301417] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer can be diagnosed as an incidental finding during the pathological examination of benign prostatic hyperplasia (BPH) specimens by Holmium laser enucleation of the prostate (HoLEP). BPH and comorbidities such as hypertension, diabetes, and dyslipidemia often coexist in elderly people. We identified which comorbidities can be used to predict the presence of incidental prostate cancer, particularly high-risk cancer, in men who had undergone HoLEP. On the basis of pathological findings of HoLEP specimens, patients with incidental cancer were categorized as low-risk (Gleason ≤6 and T1a) or high-risk (all others). Of the 654 patients who underwent HoLEP, 41 patients (6.3%) were identified as having incidental cancer (25 low-risk and 16 high-risk). There were no significant factors for overall prostate cancers. However, a significantly higher frequency of diabetes was observed in patients with high-risk cancer compared to those with BPH (31% vs. 13%; p = .033). Logistic regression analysis using prostate-specific antigen (PSA) and prostate volume (PV), and smoking showed that diabetes was an independent predictor of high-risk cancer (odds ratio, 3.15; 95% confidence interval, 1.06-9.43). Diabetes may be an important predictor of the presence of high-risk prostate cancer in men with BPH who have undergone HoLEP.
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Affiliation(s)
- Kazuhiro Ohwaki
- a Department of Urology , St. Luke's International Hospital , Tokyo , Japan
- b Health Management Center , JCHO Tokyo Shinjuku Medical Center , Tokyo , Japan
| | - Fumiyasu Endo
- a Department of Urology , St. Luke's International Hospital , Tokyo , Japan
| | - Masaki Shimbo
- a Department of Urology , St. Luke's International Hospital , Tokyo , Japan
| | - Akiko Fujisaki
- a Department of Urology , St. Luke's International Hospital , Tokyo , Japan
| | - Kazunori Hattori
- a Department of Urology , St. Luke's International Hospital , Tokyo , Japan
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Herlemann A, Wegner K, Roosen A, Buchner A, Weinhold P, Bachmann A, Stief CG, Gratzke C, Magistro G. “Finding the needle in a haystack”: oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP). World J Urol 2017; 35:1777-1782. [DOI: 10.1007/s00345-017-2048-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
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