Introduction: Holmium laser enucleation of the prostate (HoLEP) allows for the definitive management of benign prostatic hyperplasia and histopathologic analysis. The complete adenomectomy of HoLEP allows for the diagnosis of incidental prostate cancer (PCA). Outcomes data regarding the clinical progression of PCA following HoLEP is lacking. The objective of this study is to describe the clinical course of patients diagnosed with PCA after HoLEP, and identify predictors for clinical progression in this population.
Methods: HoLEP cases performed at our institution by a single surgeon from 2008-2018 were reviewed and monitored for incidentally diagnosed PCA. Clinical progression of PCA was defined as the need for additional therapeutic intervention or the development of metastatic disease. Univariate analysis was conducted using Chi-squared and T-tests when appropriate. Kaplan Meier estimates were used to evaluate survival.
Results: Of 1,288 HoLEP patients, 133 patients were diagnosed with incidental PCA. Seventeen (12.7%) patients met criteria for clinical progression at a median of 20 months postoperatively. On univariate logistic regression, predictors of clinical progression included preoperative prostate specific antigen density (PSAD) >0.15 (OR 3.4, 95% CI 1.7-6.6, p<0.01), T1b vs. T1a (OR 2.9, 95% CI 1.6-5.2), first postoperative PSA >1 (OR 2.1, 95% CI 1.9-2.3, p<0.01), PSADT <36 months (OR 9.2, 95% CI 1.15-74.8, P=0.01) and PSA velocity >0.75 (OR 14.6, 95% CI 3.5-60.7, p<0.01). When predicting clinical progression, the sensitivity of PSADT <36 months was 94%, the negative predictive values for first postop PSA >1 was 94%, PSA velocity >0.75 ng/mL/year was 95%, and PSA DT <36 months was 97%. Progression-free survival was 101.9 months in T1a vs. 61.5 months in T1b disease (p<0.01).
Conclusions: PSA kinetics are informative in predicting clinical progression following HoLEP. These parameters can be used to risk stratify patients diagnosed with incidental PCa after HoLEP. Source of