"Finding the needle in a haystack": oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP).
World J Urol
; 35(11): 1777-1782, 2017 Nov.
Article
en En
| MEDLINE
| ID: mdl-28516315
ABSTRACT
PURPOSE:
To evaluate oncologic parameters of men with bothersome LUTS undergoing surgical treatment with HoLEP or TURP.METHODS:
Five hundred and eighteen patients undergoing HoLEP (n = 289) or TURP (n = 229) were retrospectively analyzed for total PSA, prostate volume, PSA density, history of prostate biopsy, resected prostate weight, and histopathological features. Univariate and multivariate logistic regression models were used to identify independent predictors of incidental PCa (iPCa).RESULTS:
Men undergoing HoLEP had a significantly higher total PSA (median 5.5 vs. 2.3 ng/mL) and prostate volume (median 80 vs. 41 cc), and displayed a greater reduction of prostate volume after surgery compared to TURP patients (median 71 vs. 50%; all p < 0.001). With a prevalence of incidental PCa (iPCa) of 15 and 17% for HoLEP and TURP, respectively, the choice of procedure had no influence on the detection of iPCa (p = 0.593). However, a higher rate of false-negative preoperative prostate biopsies was noted among iPCa patients in the HoLEP arm (40 vs. 8%, p = 0.007). In multivariate logistic regression, we identified patient age (OR 1.04; 95% CI 1.01-1.07, p = 0.013) and PSA density (OR 2.13; 95% CI 1.09-4.18, p = 0.028) as independent predictors for the detection of iPCa.CONCLUSIONS:
Despite differences in oncologic parameters, the choice of technique had no influence on the detection of iPCa. Increased patient age and higher PSA density were associated with iPCa. A higher rate of false-negative preoperative prostate biopsies was noted in HoLEP patients. Therefore, diagnostic assessment of LUTS patients requires a more adapted approach to exclude malignancy, especially in those with larger prostates.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Hiperplasia Prostática
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Neoplasias de la Próstata
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Obstrucción del Cuello de la Vejiga Urinaria
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Adenocarcinoma
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Neoplasia Intraepitelial Prostática
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Resección Transuretral de la Próstata
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Hallazgos Incidentales
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Terapia por Láser
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Síntomas del Sistema Urinario Inferior
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
World J Urol
Año:
2017
Tipo del documento:
Article
País de afiliación:
Alemania