Presentation Authors: Seth Teplitsky*, Joon Yau Leong, Tomy Perez, Patrick Shenot, Akhil Das, Philadelphia, PA
Introduction: Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment option for patients with benign prostatic hyperplasia (BPH). Here we identify the prevalence and treatment options for incidental prostate cancer (PCa) after HoLEP. We also aim to investigate the length of survival after PCa detection and treatment.
Methods: A retrospective review, from an IRB approved database, of 515 patients that underwent a HoLEP by a single-surgeon at our institution between 2012 and 2017 was performed. All patients whose pathology report showed adenocarcinoma of the prostate were identified, and the chart was reviewed. Patients with a previously confirmed diagnosis of PCa were excluded from analysis.
Results: Of 515 patients, 32 patients pathology showed PCa, of which 28 were incidental findings (5.44%). Of these, 13 patients (46.43%) had Gleason 3+3 disease. Eight patients (28.57%) had Gleason 3+4 or Gleason 4+3 disease. The remaining seven patients (25.0%) had Gleason 4+4 or higher. 20/28 (71.4%%) had urinary retention before surgery, while 7/7 (100%) with Gleason 4+4 or higher had retention on presentation. Pathology reports showed that 16 (57.14%) of these 28 patient&[prime]s pathology showed cancer in less than 5% of the tissue, and 21/28 (75.0%) of patients had less than 25% of tissue affected. 14 of 28 (50.0%) opted for active surveillance (AS), 4 (14.29%) received radiation therapy plus hormonal treatment, 1 (3.57%) received exclusively hormonal therapy, and 1 (3.57%) received robotic prostatectomy. Of the AS group, one patient (7.14%) had disease progression and required hormonal therapy. Six (21.43%) patients were lost to follow up or followed up at an outside institution. Of the 28 patients, three are known to have died at a median of 24 months after cancer diagnosis.
Conclusions: Incidental findings of prostate cancer is not an uncommon phenomenon for those undergoing HoLEP for the relief of their BPH symptoms, and our results are consistent with previous findings. Of those identified, the most common finding is low-grade cancer for which active surveillance is a reasonable option, and will likely have a favorable outcome in their prostate cancer management. However, 25% of all cancers identified are aggressive and may present a challenge for management. All patients with Gleason 4+4 or higher had urinary retention upon presentation, and therefore patients with this presentation may be considered for different counseling, including possible pre-HoLEP prostate biopsy for those with other risk factors.