Favorable long‑term oncological and urinary outcomes of incidental prostate cancer following holmium laser enucleation of the prostate

Tominaga,Yusuke; Sadahira,Takuya; Mitsui,Yosuke; Maruyama,Yuki; Tanimoto,Ryuta; Wada,Koichiro; Munemasa,Shuhei; Kusaka,Nobuyuki; Nishiyama,Yasuhiro; Kurashige,Takushi; Nasu,Yasutomo; Hayata,Shunji

doi:10.3892/mco.2019.1839

Favorable long‑term oncological and urinary outcomes of incidental prostate cancer following holmium laser enucleation of the prostate

Authors:
- Yusuke Tominaga
- Takuya Sadahira
- Yosuke Mitsui
- Yuki Maruyama
- Ryuta Tanimoto
- Koichiro Wada
- Shuhei Munemasa
- Nobuyuki Kusaka
- Yasuhiro Nishiyama
- Takushi Kurashige
- Yasutomo Nasu
- Shunji Hayata
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Affiliations: Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680‑0873, Japan, Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700‑8558, Japan, Department of Urology, Kochi Health Sciences Center, Kochi, Kochi 781‑8555, Japan, Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
Published online on: April 8, 2019 https://doi.org/10.3892/mco.2019.1839
Pages: 605-609

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Abstract

The aim of the present study was to investigate the impact of incidental prostate cancer (IPCa), which was diagnosed by holmium laser enucleation of the prostate (HoLEP), on long‑term oncological and functional outcomes. A total of 482 patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between 2008 and 2016 at our institution were retrospectively reviewed. We defined IPCa as prostate cancer (PCa) according to the enucleated tissue of transitional zone. Therefore, 64 patients were excluded for the following reasons: Prostate‑specific antigen (PSA) ≥4.0 ng/ml and no prostate biopsy (n=46); and PSA ≥4.0 ng/ml and diagnosed with PCa by prostate biopsy performed during HoLEP (n=18). Notably, 418 patients were included in the study and divided into two groups: The BPH group and the IPCa group. For 5 years, postoperative PSA and functional outcomes were evaluated. Of 418 patients, 25 (6%) were diagnosed with IPCa by HoLEP, 21 patients (84%) had a Gleason score ≤6 and 5 patients (20%) received adjuvant therapy for PCa following HoLEP. No significant differences were observed between groups for preoperative PSA, PSA density, or urinary and sexual function outcomes; however, age at the time of HoLEP significantly differed between groups (71.7 vs. 75.5 years, P=0.026). Long‑term (5‑year) urinary outcomes demonstrated sustained improvement. Postoperative PSA increased gradually in the IPCa group (3‑year, P=0.033; 4‑year, P=0.037); International Index of Erectile Function 5 conversely decreased (5‑year, P=0.068). According to the present results, if standard PSA screening and prostate biopsy are performed, watchful waiting for IPCa is feasible, and IPCa does not impact on 5‑year urinary outcomes.

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