Abstract：
OBJECTIVE: Despite advancements in prostate multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB), the management of incidental prostate cancer (IPCa) after surgery for benign prostatic obstruction (BPO) remains unclear. The aim of this retrospective study is to determine the prevalence of IPCa in our cohort and identify potential predictors for its occurrence.
METHODS: We enrolled patients underwent TURP or simple prostatectomy for BPO at our high-volume center between January 2020-December 2022. Data on age, pre-operative total PSA (tPSA) and PSA density (PSAd) levels, prostate volume, previous MRI, biopsies, specimen weight, rates of positive tissue slices, ISUP score and three-month tPSA were collected.
RESULTS: Of 454 patients with negative digital rectal examination who underwent BPO surgery, 74 patients (16.3%) were found to have IPCa. Of these, 33 patients (44.6%) had undergone previous mpMRI. Among the patients who had mpMRI, 23 had negative mpMRI results for suspected prostate cancer, while 10 had positive mpMRI findings (PIRADS ≥ 3) but no evidence of tumor upon FB. KW analysis indicates that PSAd was statistically associated with higher ISUP score, while at univariable regression analysis negative mpMRI (p = 0.03) was the only potential predictor for IPCa.
CONCLUSIONS: Among the ISUP groups, PSAd showed a correlation with the tumor, while negative mpMRI was protective against clinically significant PCa. In the era of mpMRI and FB, the IPCa rates found at our center is higher than reported in existing literature and if it were confirmed with further studies, maybe there is a need for expansion in urology guidelines.
METHODS: We enrolled patients underwent TURP or simple prostatectomy for BPO at our high-volume center between January 2020-December 2022. Data on age, pre-operative total PSA (tPSA) and PSA density (PSAd) levels, prostate volume, previous MRI, biopsies, specimen weight, rates of positive tissue slices, ISUP score and three-month tPSA were collected.
RESULTS: Of 454 patients with negative digital rectal examination who underwent BPO surgery, 74 patients (16.3%) were found to have IPCa. Of these, 33 patients (44.6%) had undergone previous mpMRI. Among the patients who had mpMRI, 23 had negative mpMRI results for suspected prostate cancer, while 10 had positive mpMRI findings (PIRADS ≥ 3) but no evidence of tumor upon FB. KW analysis indicates that PSAd was statistically associated with higher ISUP score, while at univariable regression analysis negative mpMRI (p = 0.03) was the only potential predictor for IPCa.
CONCLUSIONS: Among the ISUP groups, PSAd showed a correlation with the tumor, while negative mpMRI was protective against clinically significant PCa. In the era of mpMRI and FB, the IPCa rates found at our center is higher than reported in existing literature and if it were confirmed with further studies, maybe there is a need for expansion in urology guidelines.
摘要：
目的：尽管前列腺多参数磁共振成像（mpMRI）和融合活检（FB）取得了进展，良性前列腺梗阻(BPO)手术后偶发前列腺癌(IPCa)的治疗方法尚不清楚.这项回顾性研究的目的是确定我们队列中IPCa的患病率，并确定其发生的潜在预测因素。
方法：我们招募了在2020年1月至2022年12月期间在我们的高容量中心接受TURP或单纯前列腺切除术的患者。年龄数据,术前总PSA（tPSA）和PSA密度（PSAd）水平，前列腺体积,之前的MRI,活检,试样重量,阳性组织切片率，收集ISUP评分和3个月tPSA。
结果：在454例直肠指检阴性的患者中，发现74例患者（16.3%）患有IPCa。其中,33例患者（44.6%）以前接受过mpMRI。在接受过mpMRI的患者中，23名疑似前列腺癌的mpMRI结果为阴性，而10名患者的mpMRI表现为阳性（PIRADS≥3），但在FB时没有肿瘤的证据。KW分析表明，PSAd与较高的ISUP得分有统计学关联，而在单变量回归分析中，MPMRI阴性（p=0.03）是IPCa的唯一潜在预测因子。
结论：在ISUP组中，PSAd与肿瘤有相关性,而阴性的mpMRI对具有临床意义的PCa具有保护作用。在mpMRI和FB时代，我们中心发现的IPCa率高于现有文献中的报道，如果进一步研究证实，也许有必要扩大泌尿外科指南。
方法：我们招募了在2020年1月至2022年12月期间在我们的高容量中心接受TURP或单纯前列腺切除术的患者。年龄数据,术前总PSA（tPSA）和PSA密度（PSAd）水平，前列腺体积,之前的MRI,活检,试样重量,阳性组织切片率，收集ISUP评分和3个月tPSA。
结果：在454例直肠指检阴性的患者中，发现74例患者（16.3%）患有IPCa。其中,33例患者（44.6%）以前接受过mpMRI。在接受过mpMRI的患者中，23名疑似前列腺癌的mpMRI结果为阴性，而10名患者的mpMRI表现为阳性（PIRADS≥3），但在FB时没有肿瘤的证据。KW分析表明，PSAd与较高的ISUP得分有统计学关联，而在单变量回归分析中，MPMRI阴性（p=0.03）是IPCa的唯一潜在预测因子。
结论：在ISUP组中，PSAd与肿瘤有相关性,而阴性的mpMRI对具有临床意义的PCa具有保护作用。在mpMRI和FB时代，我们中心发现的IPCa率高于现有文献中的报道，如果进一步研究证实，也许有必要扩大泌尿外科指南。
