MP59-18 THE INCIDENCE OF CLINICALLY SIGNIFICANT PROSTATE CANCER AFTER HoLEP

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP59-18 THE INCIDENCE OF CLINICALLY SIGNIFICANT PROSTATE CANCER AFTER HoLEP Ali S Antar, Tudor Borza, Ethan Richmond, Glenn O Allen, Jordan R Krieger, Margaret A Knoedler, Christopher M Manakas, Wei Huang, Dan R Gralnek, and Matthew D Grimes Ali S AntarAli S Antar More articles by this author , Tudor BorzaTudor Borza More articles by this author , Ethan RichmondEthan Richmond More articles by this author , Glenn O AllenGlenn O Allen More articles by this author , Jordan R KriegerJordan R Krieger More articles by this author , Margaret A KnoedlerMargaret A Knoedler More articles by this author , Christopher M ManakasChristopher M Manakas More articles by this author , Wei HuangWei Huang More articles by this author , Dan R GralnekDan R Gralnek More articles by this author , and Matthew D GrimesMatthew D Grimes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rates of incidental prostate cancer (iPCa) after Holmium Laser Enucleation of the Prostate (HoLEP) are higher than in other bladder outlet surgeries. Management presents a challenge considering the effects of HoLEP on anatomy and other causes of mortality in the older population. We examined cancer characteristics and initial management of patients with iPCa after HoLEP to understand the significance of these incidentally discovered cancers. METHODS: Patients with iPCa were identified over a 4 year period from a prospectively maintained institutional database. Clinical data collected included preoperative PSA levels, cancer stage, grade, initial management, post operative PSA, staging imaging or biopsy. We defined clinically significant cancers as those where treatment other than watchful waiting was recommended by NCCN guidelines based on predicted life expectancy, which was estimated using the Social Security Life Expectancy Calculator. RESULTS: 183/913 (20%) patients were diagnosed iPCa after HoLEP. 133 patients (73%) had clinically significant and 50 patients (27%) had clinically insignificant iPCa. Of clinically significant cancers, 7 patients with high risk PCa were managed with upfront local treatment and the rest underwent PSA surveillance (Figure 1). 11 experienced a PSA increase and underwent local treatment after confirmatory biopsy: 3 underwent RALP, 7 underwent XRT and one underwent ADT, all with appropriate PSA response to treatment. The clinically insignificant population underwent PSA observation. 9 were lost to follow up and 5 experienced a PSA increase triggering intervention: 4 underwent XRT and 1 underwent ADT with appropriate PSA response. At a mean follow-up of 16.3 months (IQR 7.9–13.4 months), there were 6 deaths, all from non-cancer related causes. CONCLUSIONS: Despite the low risk nature of many post-HoLEP iPCA, the majority were classified as clinically significant cancers based on NCCN guidelines. Data driven guidelines for pre-operative screening evaluation and post-operative management of iPCa after HoLEP are critical given the frequency and clinical implications these cancer diagnoses. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e815 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali S Antar More articles by this author Tudor Borza More articles by this author Ethan Richmond More articles by this author Glenn O Allen More articles by this author Jordan R Krieger More articles by this author Margaret A Knoedler More articles by this author Christopher M Manakas More articles by this author Wei Huang More articles by this author Dan R Gralnek More articles by this author Matthew D Grimes More articles by this author Expand All Advertisement PDF downloadLoading ...