Presentation Authors: WEN DONG*, CHUN JIANG, WEIBIN XIE, JIAN HUANG, HAO HUANG, XINXIANG FAN, Guangzhou, China, People's Republic of
Introduction: Holmium laser enucleation of the prostate (HoLEP) has become a popular alternative to TURP for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH). Previous studies indicated that HoLEP may have a higher rate of incidental prostate cancer (iPCa) detection because of a more efficient tissue removed during surgery. However, some other studies reported itâ€™s identical for both procedures. In this study, we aim to evaluate whether the surgical procedure itself (HoLEP vs. TURP) influences iPCa detection by analysis of a large cohort of patients.
Methods: six hundred and two patients undergoing HoLEP (n = 292) or TURP (n = 312) were retrospectively analyzed for total PSA, prostate volume, PSA density, history of prostate biopsy, resected prostate weight, and histopathological features. IPSS, Qmax, PVR were also collected before and after surgery. Parameters were analyzed by Fisherâ€™s exact test and T test or Mannâ€“Whitney U test for dichotomous and continuous variables, respectively. Univariate and multivariate logistic regression removed used to identify independent predictors of incidental PCa (iPCa).
Results: Median patient age was 66 and 65 years in the HoLEP and bTURP group, respectively. Median preoperative total PSA was 3.7 ng/ml for HoLEP and 3.3 ng/ml for bTURP patients(p=0.08). Median preoperative prostate volume was 64.0 cc for HoLEP and 58.0 cc for bTURP(p=0.02) . Mean percentage of tissue removed by HoLEP and bTURP was 69.5% and 51.2% (p < 0.001), respectively. IPCa was found in 12.3% of HoLEP specimens compared to 6.1% in bTURP (p = 0.01). There were no differences for IPSS and PVR reduction, Qmax increase for each procedure. In multivariate logistic regression, we identified the choice of procedure (OR 1.46; 95% CI 1.24â€“1.65, p = 0.04) and PSA density (OR 2.13; 95% CI 1.09â€“4.18, p = 0.028) as independent predictors for the detection of iPCa.
Conclusions: In this study, HoLEP provides a significantly higher iPCa detection than bTURP although most of them were removed cancer. ). might be a result of a more efficient tissue removal during HoLEP. HoLEP had similar effect for resolution of LUTS as bTURP.