Affiliation:
1. Department of Urology Sendai City Hospital Sendai Japan
2. Department of Urology Tohoku University Graduate School of Medicine Sendai Japan
3. Department of Pathology Sendai City Hospital Sendai Japan
Abstract
ObjectivesTo 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.MethodsPatients 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.ResultsOf 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.ConclusionsPatients 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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