775 Incidental Prostate Cancer Following Holmium Laser Enucleation of Prostate

Abstract

Abstract Aim To review the incidence and predictors of incidental prostate cancer (IPCa) following Holmium Laser Enucleation of Prostate (HoLEP). Method This was a departmental retrospective review of 148 patients undergoing HoLEP between 2017 to 2022. Demographic, perioperative, and pathologic data were gathered. For patients diagnosed with IPCa, information on work up, management, and oncologic outcome were gathered. Univariate and multivariate logistic regression were used to identify predictors of IPCa. Results 13 patients had IPCa (8.78%). The mean age was 73.4 years (SD 6.6); pre-procedural prostate volume 85.3ml (SD 32.9); pre-procedural PSA 6.7ng/ml (SD 6.1); PSA density 0.08ng/mL2 (SD 0.06); weight of enucleated tissue 52.8g (SD 39.4); enucleated tissue PSA density 0.14ng/mL2 (SD 0.10). Prostate volume was strongly correlated with weight of enucleated tissue (Pearson 0.8, P = 0.006). Lower pre-procedure prostate volume was the only significant predictor of IPCa (P = 0.018). A prostate volume of <99.0ml had sensitivity of 0.67 and specificity of 0.63 (Area under ROC = 0.70). Mean reduction in post-procedural PSA was 5.6ng/ml (SD 6.3). 61.5% (n = 8) patients had clinically significant IPCa (Gleason≥GG2 or >5% volume). 3 patients had radical treatment, and 5 patients were under active surveillance. The other 5 patients with insignificant IPCa continue on active surveillance (AS) (n = 3) and watchful waiting (WW) (n = 2). None with insignificant disease had disease progression. Conclusions Of patients with IPCa, 61.5% (n = 8) patients had clinically significant IPCa, and the optimal mode of detecting incidental clinically significant prostate cancer, prior to HoLEP might include pre-operative MRI in selected patients based on gland size.