Incidental Prostate Cancer Diagnosis During Holmium Laser Enucleation: Assessment of Predictors, Survival, and Disease Progression

ObjectiveTo determine the prevalence and predictors of incidental prostate cancer (IPCa) after Holmium laser enucleation of the prostate (HoLEP) and to assess its functional and oncological outcomes.MethodsA prospectively maintained database was reviewed for cases with IPCa at the time of HoLEP. Patients with preoperative PCa were excluded. Patients were divided into two groups based on the presence (group I [GI]) or absence of cancer (group II [GII]) in histopathology. Univariate and multivariate logistic regression analyses were performed.ResultsOf 1242 patients, 70 (5.64%) were identified to have IPCa. Prostate size was comparable between both groups. GI patients had significantly higher preoperative prostate-specific antigen (PSA) and total PSA density (tPSAD) compared to cancer-free patients. T1a and T1b adenocarcinomas were detected in 54 (77.1%) and 16 (22.9%) patients, respectively. After a median follow-up of 48 (1-171) months, both groups were comparable in all functional outcomes but the quality of life was significantly better in GII. Patients' age and preoperative tPSAD independently predicted IPCa after HoLEP. A tPSAD cutoff value of 0.092 has a sensitivity and specificity of 0.83 and 0.67, respectively. Seven patients (11.7%) needed adjuvant therapy while other GI patients opted for active surveillance. The Kaplan-Meier analysis demonstrated an overall survival of 72.8% at 5 years and 63.5% at 10 years for patients with PCa.ConclusionPCa is not uncommonly identified after HoLEP, even in those with negative preoperative biopsies. In older patients, total PSAD could be a predictor using a cutoff <0.1. After HoLEP, active surveillance for low-grade PCa carries good functional and oncological outcomes.