Incidence and associated factors for incidental prostate cancer following endoscopic enucleation for benign prostate hyperplasia performed by a single urologist

Sorokin N.I., Strigunov A.A., Nesterova O.Yu., Pshikhachev A.M., Burlakov I.D., Oleynikova N.A., Varentsov M.G., Bondar I.V., Tereshina A.D., Veriaskina A.E., Kamalov A.A.

1) University Clinic, Medical Scientific and Educational Institute, Lomonosov Moscow State University. Moscow, Russian Federation; 2) Faculty of Fundamental Medicine, Medical Scientific and Educational Institute, Lomonosov Moscow State University, Moscow, Russian Federation; 3) Medical Affairs at the Central Clinical Hospital of Civil Aviation, Moscow, Russian Federation; 4) Мoscow State Technical University, Department of Urology and General Surgery of the Medical Institute, Maykop, Republic of Adygea, Russian Federation

Objective: to assess the incidence of incidental prostate cancer and associated factors after endoscopic enucleation of benign prostate hyperplasia performed by single urologist. Materials and methods: a retrospective study included 753 patients after endoscopic enucleation of benign prostate hyperplasia performed by single urologist with more than 3000 enucleation experience. Bipolar enucleation was performed in 22,2% of cases and thulium fiber enucleation (ThuFLEP) was performed in 77,8% of cases. Results: incidental prostate cancer after endoscopic enucleation of benign prostate hyperplasia performed by single urologist was detected in 6,7% cases (51 patients): in 8,4% – after bipolar enucleation, in 5.3% – after ThuFLEP (p=0,141). Patients with incidental prostate cancer were older (median age 71,5 years and 67,0 years, respectively, p<0.001), had smaller prostate volume (68,0 cm3 and 83,0 cm3, respectively, p=0,048), had higher PSA density (0,08 ng/ml/cm3 and 0,05 ng/ml/cm3, respectively, p=0,006). Univariable logistic regression analysis revealed that additional factor increasing the chance of incidental prostate cancer after endoscopic enucleation is lower IPSS values (OR=0,948; 95%CI=0,897-0,999; p=0,045). During the ROC analysis for these parameters, it was shown that the quality of the parameters «age» and «PSA density» as predictors of incidental prostate cancer after endoscopic enucleation is average (AUC 0,662 and 0,624, respectively), while the parameters «prostate volume» and «IPSS» are unsatisfactory (AUC 0,584 and 0,555, respectively). The value of 68,5 years was chosen as the cut-off point for the age of patients: if the patient is older, it was predicted a high chance of incidental prostate cancer with sensitivity and specificity of 69,6% and 57,4%, respectively. The value of 0,0543 ng/ml/cm3 was chosen as the cut-off point for PSA density: if the PSA density is higher, it was predicted a high chance of incidental prostate cancer with sensitivity and specificity of 68,2% and 56,1%, respectively. Conclusions: in the present cohort of patients after endoscopic enucleation for benign prostate hyperplasia, there is a low incidence of incidental prostate cancer (6.7%), which, together with the absence of strong predictors, indicates a full competent examination before planning endoscopic enucleation. Nevertheless, before surgery, it is important to pay attention to such parameters as the older age and higher PSA density associated with a higher chance of incidental prostate cancer.

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About the Authors

Corresponding author: O.Yu. Nesterova – M.D., Cand. Sc. (Med), Urologist, Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute, Lomonosov Moscow State University; senior lecturer of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute, Lomonosov Moscow State University, Moscow, Russia. e-mail: oy.nesterova@gmail.com

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