Changes in serum PSA after endoscopic enucleation of the prostate are predictive for the future diagnosis of prostate ca
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ORIGINAL ARTICLE
Changes in serum PSA after endoscopic enucleation of the prostate are predictive for the future diagnosis of prostate cancer E. Lambert1 · M. Goossens1 · E. Palagonia1 · J. Vollemaere1 · E. Mazzone2,3 · P. Dell’Oglio2,4 · E. Pauwels1 · R. De Groote1 · F. D’Hondt1 · A. Mottrie1,2 · G. De Naeyer1 · P. Schatteman1 Received: 14 June 2020 / Accepted: 5 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose After Endoscopic Enucleation of the Prostate (EEP) for benign prostatic obstruction (BPO), men remain at risk for prostate cancer (PCa). Significant PSA changes occur after enucleation, which interfere with later screening for PCa. It remains unclear which patients need further diagnostic investigations for PCa after EEP. The goal of this study was to identify an independent predictor for PCa diagnosis after Holmium Laser Enucleation of the Prostate (HoLEP) in patients whose HoLEP resection specimen did not show PCa. Methods Data of 773 patients who underwent HoLEP for BPO between 2010 and 2018 in a referral center were analyzed. Exclusion criteria were PCa detection in the HoLEP specimen or absence of post-operative PSA values. Patients were divided in a PCa group and Control group depending on whether or not PCa was detected during follow-up after HoLEP. The predictive value for future diagnosis of PCa of different forms of PSA-change after HoLEP was analyzed by multivariate Cox regression and ROC analysis. Results Overall, 24 (4.2%) patients developed PCa after HoLEP. At 5 year follow-up, the PCa-free survival rate was 85%. First post-operative PSA was an independent predictor of PCa diagnosis after HoLEP (HR 1.106, 95% CI 1.074–1.139, p 1.73 ng/ml within the first year after HoLEP, rigorous follow-up and diagnostic investigations for PCa are indicated. Keywords HoLEP · Benign prostatic obstruction · Prostate cancer · PSA Abbreviations AUC Area Under the Curve BPH Benign Prostatic Hyperplasia Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03444-0) contains supplementary material, which is available to authorized users. * E. Lambert [email protected] 1
Deparment of Urology, Onze-Lieve-Vrouw Ziekenhuis Aalst, Aalst, Belgium
2
ORSI Acadamy, Melle, Belgium
3
Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
4
Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
BPO Benign Prostatic Obstruction CI Confidence interval CRA Cox Regression Analysis DRE Digital Rectal Examination HoLEP Holmium Laser Enucleation of the Prostate HR Hazard ratio PCa Prostate Cancer PSA Prostate Specific Antigen ROC Receiver Operating Characteristic SP Simple Prostatectomy TURP Transurethral Resection of the Prostate
Introduction Endoscopic Enucleation of the Prostate (EEP) has gained popularity in the last decades and is becoming the new standard surgical treatment for lower urinar
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