Does incidental prostate cancer after holmium laser enucleation of the prostate cause serious clinical problems?: Retrospective study

We aimed to investigate the predictive factors, oncologic course and functional outcomes of incidental prostate adenocarcinoma (iPCa) after holmium laser enucleation of the prostate (HoLEP). This study included 577 patients who had undergone HoLEP. Patients with a preoperative diagnosis of prostate cancer or suspected prostate cancer were excluded from the study. Patients were divided into group-1 (iPCa) and group-2 benign prostatic hyperplasia (BPH). Oncological and functional outcomes and complications at 1, 6, and 12 months were compared between the groups. To evaluate the association between clinical and demographic variables, a multivariable-adjusted logistic regression analysis was performed. In total 577 patients were included. iPCa was detected in 2.77% (16/577) of the patients who underwent HoLEP. Prostate specific antigen density had a sensitivity of 50% and specificity of 80.30% (cut-off > 0.07) for predicting iPCa (odds ratio: 0.264; 95% confidence interval: 0.099-0.430; P = .024). In the oncological follow-up of the iPCa and BPH groups, there was no statistically significant difference in prostate specific antigen level at 36 month (P = .874). Only 1 patient was found to have Gleasen grade (3 + 4) (clinically significant) prostate cancer, since there was no progression in prostate specific antigen follow-up, no additional treatment was performed. The functional results in both the groups were similar at 36 month (P < .05). Urethral stricture and urinary retention rates were higher in the iPCa group (4/16, 25%). The incidence of urinary infections was higher in the BPH group (1.06%; 6/561). At 36 months, and all patients were continent. The incidence of iPCa detected after HoLEP was low, and most cases were clinically insignificant.