Presentation Authors: Vincent Misrai*, Toulouse, France, Benoit Peyronnet, Rennes, France, Benjamin Pradere, Tours, France, Benoit Bordier, Julien Guillotreau, Alexandre Gryn, Toulouse, France, Kevin C. Zorn, Montreal, Canada
Introduction: Incidental prostate cancer (IPCa) detection is estimated between 6 and 12% on open prostatectomy or morcellation sample chips analysis. High preoperative PSA level has been identified as a potential predictive factor. However, a significant increase in the value of PSA is frequently observed in large glands.The objective was to evaluate the accuracy of high preoperative PSA level for IPCa detection in patients underwent endoscopic enucleation of the prostate (EEP) for large glands.
Methods: Perioperative data from 308 consecutive patients underwent EEP for benign prostatic obstruction between July 2013 and December 2017 were collected prospectively and gathered in 3 groups according to preoperative PSA level: LOW-PSA ( < 4ng/mL), INTERMEDIATE-PSA (4 â‰¤PSA < 10ng/mL) and HIGH-PSA (â‰¥10ng/mL). Patients were matched in each group based on propensity score according to age, the use of 5alpha-reductase inhibitors and the prostatic volume (Figure 1). The detection rate of IPCa was compared between 3 groups.
Results: Patient characteristics were similar between groups in terms of age, prostate volume and I-5AR use. The PSA density was significantly higher in HIGH-PSA group (p < 0.0001). The median prostatic volume was greater than 100 grams in the 3 groups. The overall IPCa rate was similar between the 3 groups with no difference in tumor stage and Gleason score (Table 1). The rate of clinically significant IPCa was significant when preoperative PSA was above 4ng/mL (9.1% vs 0%) without any difference between INTERMEDIATE and HIGH-PSA groups. PSA decrease significantly from baseline in all groups, but PSA drop was greater in HIGH-PSA group.
Conclusions: In this series, overall IPCa detection was similar regardless of the preoperative PSA level. Although the rate of clinically significant IPCa was substantial for PSA> 4 ng/mL, IPCa did not increase for PSA â‰¥10ng/mL.