Older patient age and greater preoperative total PSA density (tPSAD) independently predict which men undergoing holmium laser enucleation (HoLEP) will have prostate cancer diagnosed incidentally, according to a recent report.

In a study of 1,242 men undergoing HoLEP for benign prostatic hyperplasia, 70 (5.64%) had prostate cancer (PCa) diagnosed incidentally. Of the 70 patients, 54 (77.1%) had T1a tumors and 16 (22.9%) had T1b tumors, Mohamed A. Elkoushy, MD, of McGill University Health Centre in Montreal, Canada, and colleagues reported online ahead of print in Urology. Prostate size was comparable in the patients with and without PCa. At the time of HoLEP, the mean age of the patients was significantly higher in the PCa than non-PCa group (75.8 vs. 71.9 years). Preoperatively, the mean tPSAD was significantly greater in the PCa than the non-PCa group (0.22 vs. 0.07).

In multivariate analysis, older age and greater preoperative tPSAD were the only independent predictors of PCa after HoLEP, according to the investigators.

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The researchers identified a tPSAD cutoff value of 0.092 as a cause of suspicion for PCa in patients undergoing HoLEP. This cutoff value had a sensitivity and specificity of 0.83 and 0.67, respectively.

The PCa patients had overall survival rates of 72.8% and 63.5% at 5 and 10 years, respectively, based on a Kaplan-Meier analysis.