Significance of prostate-specific antigen-related factors in incidental prostate cancer treated by holmium laser enucleation of the prostate

Purpose: Recently, more vaporization techniques are available for the treatment of benign prostate hyperplasia (BPH). However, the detection of incidental prostate cancer (Pca) is impossible in vaporization techniques because of unavailability prostate tissue for histopathological analysis. To evaluate the clinical backgrounds and the usefulness of prostate-specific antigen (PSA)-related factors in incidental Pca, we employed our BPH patients cohort treated by holmium laser enucleation of the prostate (HoLEP).

Methods: A total of 365 HoLEPs were performed by a single surgeon. The pathological results and pre- and post-HoLEP PSA, PSA density and PSA velocity were analyzed retrospectively.

Results: Incidental Pca was identified in 25 (6.8 %) of the 365 patients treated with HoLEP. There were significant differences between BPH and Pca in terms of prostate volume (55.5 vs. 47 ml, p = 0.0365), preoperative PSA (4.50 vs. 7.14 ng/ml, p = 0.0107), PSA density (0.079 vs. 0.155 ng/ml/cm³, p = 0.0005), and postoperative PSA velocity (0.04 vs. 0.22 ng/ml/year, p = 0.0033), respectively. Comparisons of Gleason score subgroups in the 25 patients with incidental Pca identified significant differences in preoperative PSA (6.06 vs. 21.6 ng/ml, p = 0.0191) and postoperative PSA velocity (0.185 vs. 1.32 ng/ml/year, p = 0.0382) between the Gleason score 3 + 3 and Gleason score >3 + 3 groups, respectively.

Conclusions: Risk factors associated with incidental Pca were smaller prostate volume, higher preoperative PSA, and higher PSA density. Postoperative PSA velocity was also significantly increased in patients with incidental Pca, especially those with higher Gleason score. These finding may be useful in incident Pca patients treated by the vaporization technique.