Presented by: Hansen Lui MD, MS
UC Davis Health

Introduction

Higher rates of incidental prostate cancer (iPCa) are expected after holmium laser enucleation of the prostate (HoLEP) compared to transurethral resection owing to larger volumes of tissue resected. While patients with insignificant disease are often placed on active surveillance (AS), a small portion will have clinically significant residual disease and warrant further staging and treatment. Our objective was to assess predictors of clinically significant residual disease and treatment after HOLEP. 

Materials

We retrospectively reviewed patients who underwent HoLEP from February 2020 to November 2021 at a single institution, with follow up through September 2022. Patients with iPCa on AS were compared to those who underwent treatment. HoLEP pathology, post-operative PSA, and post-operative PSA density (pPSAD= post-op PSA/residual prostate volume) were assessed. Post-HoLEP staging MRI was obtained in patients based on age and pathology.

Results

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A total of 193 patients underwent HOLEP. The rates of iPCa and Grade Group 2+ (GG2) was 16% (n=31) and 7% (n=14), respectively. Three patients were excluded due to lost to follow-up. Six patients were treated with localized (n=4) or systemic therapy (n=2). Compared to AS, patients who received treatment had more GG2+ disease (83.3 vs 31.8%, p=0.02), a higher percentage of cancer in their pathology (24.3 ± 16.9 vs 2.0 ± 2.3%, p<0.001) and higher post-operative PSA (16.2 ± 23.6 vs 1.4 ± 1.9 ng/mL, p<0.001) and pPSAD (1.5 ± 2.1 vs 0.1 ± 0.1 ng/mL2, p<0.001). On post-HoLEP staging MRI, 66.7% of those who received treatment had PIRADS 3-5 lesions, compared to 18.2% in those on AS (p=0.04). 

Conclusion

Pathologic grade, percentage of prostate cancer in the tissue, and post-operative PSA and pPSAD can help inform those who warrant staging MRI, and may need treatment after HoLEP. Additional longitudinal studies are required to further stratify prostate cancer progression risk within the iPCa population.

Funding

None

Co-Authors

Steven Monda, MD
UC Davis Health

Onika Noel, MD, PHD
University of Texas, San Antonio

Abdisalam Hassan,
UC Davis Health

Noah Canvasser, MD
UC Davis Health