Incidence and associated factors for incidental prostate cancer following endoscopic enucleation for benign prostate hyperplasia performed by a single urologist

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Abstract

Objective: to assess the incidence of incidental prostate cancer and associated factors after endoscopic enucleation of benign prostate hyperplasia performed by single urologist.

Materials and methods: a retrospective study included 753 patients after endoscopic enucleation of benign prostate hyperplasia performed by single urologist with more than 3000 enucleation experience. Bipolar enucleation was performed in 22,2% of cases and thulium fiber enucleation (ThuFLEP) was performed in 77,8% of cases.

Results: incidental prostate cancer after endoscopic enucleation of benign prostate hyperplasia performed by single urologist was detected in 6,7% cases (51 patients): in 8,4% – after bipolar enucleation, in 5.3% – after ThuFLEP (p=0,141). Patients with incidental prostate cancer were older (median age 71,5 years and 67,0 years, respectively, p<0.001), had smaller prostate volume (68,0 cm3 and 83,0 cm3, respectively, p=0,048), had higher PSA density (0,08 ng/ml/cm3 and 0,05 ng/ml/cm3, respectively, p=0,006). Univariable logistic regression analysis revealed that additional factor increasing the chance of incidental prostate cancer after endoscopic enucleation is lower IPSS values (OR=0,948; 95%CI=0,897-0,999; p=0,045). During the ROC analysis for these parameters, it was shown that the quality of the parameters «age» and «PSA density» as predictors of incidental prostate cancer after endoscopic enucleation is average (AUC 0,662 and 0,624, respectively), while the parameters «prostate volume» and «IPSS» are unsatisfactory (AUC 0,584 and 0,555, respectively). The value of 68,5 years was chosen as the cut-off point for the age of patients: if the patient is older, it was predicted a high chance of incidental prostate cancer with sensitivity and specificity of 69,6% and 57,4%, respectively. The value of 0,0543 ng/ml/cm3 was chosen as the cut-off point for PSA density: if the PSA density is higher, it was predicted a high chance of incidental prostate cancer with sensitivity and specificity of 68,2% and 56,1%, respectively.

Conclusions: in the present cohort of patients after endoscopic enucleation for benign prostate hyperplasia, there is a low incidence of incidental prostate cancer (6.7%), which, together with the absence of strong predictors, indicates a full competent examination before planning endoscopic enucleation. Nevertheless, before surgery, it is important to pay attention to such parameters as the older age and higher PSA density associated with a higher chance of incidental prostate cancer.

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About the authors

Nikolay I. Sorokin

Lomonosov Moscow State University

Email: nisorokin@mail.ru
ORCID iD: 0000-0001-9466-7567

M.D., Dr.Sc.(Med), Prof., Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute; Leading Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky Prospekt, building 10, Moscow, 119192

Andrey A. Strigunov

Lomonosov Moscow State University

Email: an-strigunov@yandex.ru
ORCID iD: 0000-0003-4518-634X

M.D., Cand. Sc. (Med), Urologist; Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute; University Clinic, Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky Prospekt, building 10, Moscow, 119192

Olga Yu. Nesterova

Lomonosov Moscow State University

Author for correspondence.
Email: oy.nesterova@gmail.com
ORCID iD: 0000-0003-3355-4547

M.D., Cand. Sc. (Med), Urologist, Researcher, Urology and Andrology Unit, University Clinic, Medical Scientific and Educational Institute, senior lecturer of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

Akhmedkhan M. Pshikhachev

Medical Affairs at the Central Clinical Hospital of Civil Aviation; Мoscow State Technical University

Email: pshich@yandex.ru
ORCID iD: 0000-0002-4424-3261

Dr.Sc.(Med), Professor, Deputy Chief Physician for Medical Affairs at the Central Clinical Hospital of Civil Aviation; Acting Head and Professor of the Department of Urology and General Surgery at the Maykop State Technological University Medical Institute

Russian Federation, 125367, Moscow, sh. Ivankovskoe, 7; 191 Pervomayskaya str., Maykop, Republic of Adygea, 385000

Ilya D. Burlakov

Lomonosov Moscow State University

Email: forffmmsu@gmail.com
ORCID iD: 0009-0000-9115-7799

Postgrad. student, of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

Nina A. Oleynikova

Lomonosov Moscow State University

Email: ale_x_05@mail.ru
ORCID iD: 0000-0001-8564-8874

M.D. Cand. Sc. (Med); Senior Researcher of the Unit of Clinical Medicine, University Clinic, Medical Scientific and Educational Institute; Assistant of the Department of Physiology and General Medicine, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

Michael G. Varentsov

Lomonosov Moscow State University

Email: miha78st@gmail.com
ORCID iD: 0009-0000-8649-6681

Postgrad. student, of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

Ilya V. Bondar

Lomonosov Moscow State University

Email: Bondarila485@gmail.com
ORCID iD: 0009-0004-7079-2434

6th grade student of Faculty of Fundamental Medicine Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

Anastasia D. Tereshina

Lomonosov Moscow State University

Email: tereshinaanastasia51@gmail.com
ORCID iD: 0009-0008-0589-2438

5th grade student of Faculty of Fundamental Medicine Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

Arina E. Veriaskina

Lomonosov Moscow State University

Email: arina.ver.15@mail.ru
ORCID iD: 0009-0008-6926-2195

5th grade student of Faculty of Fundamental Medicine Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

Armais A. Kamalov

Lomonosov Moscow State University

Email: armais.kamalov@rambler.ru
ORCID iD: 0000-0003-4251-7545

M.D., Dr.Sc.(Med), Full Prof., Academician of the Russian Academy of Sciences; Director, University Clinic, Medical Scientific and Educational Institute; Head Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute

Russian Federation, 27 Lomonosovsky ave., building 1, Moscow, 119192

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2. Fig. 1. Statistically significantly different parameters of patients with and without incidental prostate cancer after endoscopic enucleation of prostate hyperplasia

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3. Fig. 2. ROC curves for potential risk factors for incident prostate cancer: A – age, B – prostate volume, C – IPSS, D – PSA density.

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