Objective: To investigate the value of standard [digital rectal examination (DRE), PSA] and advanced (mpMRI, prostate biopsy) clinical evaluation for prostate cancer (PCa) detection in contemporary patients with clinical bladder outlet obstruction (BOO) scheduled for Holmium laser enucleation of the prostate (HoLEP). Material and Methods: We retrospectively analyzed 397 patients, who were referred to our tertiary care laser center for HoLEP due to BOO between 11/2017 and 07/2020. Of those, 83 (20.7%) underwent further advanced clinical PCa evaluation with mpMRI and/or prostate biopsy due to elevated PSA and/or lowered PSA ratio and/or suspicious DRE. Logistic regression and binary regression tree models were applied to identify PCa in BOO patients. Results: An mpMRI was conducted in 56 (66%) of 83 patients and revealed PIRADS 4/5 lesions in 14 (25%) patients. Subsequently, a combined systematic randomized and MRI-fusion biopsy was performed in 19 (23%) patients and revealed in PCa detection in four patients (5%). A randomized prostate biopsy was performed in 31 (37%) patients and revealed in PCa detection in three patients (4%). All seven patients (9%) with PCa detection underwent radical prostatectomy with 29% exhibiting non-organ confined disease. Incidental PCa after HoLEP (n = 76) was found in nine patients (12%) with advanced clinical PCa evaluation preoperatively. In univariable logistic regression analyses, PSA, fPSA ratio, and PSA density failed to identify patients with PCa detection. Conversely, patients with a lower International Prostate Symptom Score (IPSS) and PIRADs 4/5 lesion in mpMRI were at higher risk for PCa detection. In multivariable adjusted analyses, PIRADS 4/5 lesions were confirmed as an independent risk factor (OR 9.91, p = 0.04), while IPSS did not reach significance (p = 0.052). Conclusion: In advanced clinical PCa evaluation mpMRI should be considered in patients with elevated total PSA or low fPSA ratio scheduled for BOO treatment with HoLEP. Patients with low IPSS or PIRADS 4/5 lesions in mpMRI are at highest risk for PCa detection. In patients with a history of two or more sets of negative prostate biopsies, advanced clinical PCa evaluation might be omitted.
Objective: To investigate the value of standard [digital rectal examination (DRE), PSA] and advanced (mpMRI, prostate biopsy) clinical evaluation for prostate cancer (PCa) detection in contemporary patients with clinical bladder outlet obstruction (BOO) scheduled for Holmium laser enucleation of the prostate (HoLEP). Material and Methods: We retrospectively analyzed 397 patients, who were referred to our tertiary care laser center for HoLEP due to BOO between 11/2017 and 07/2020. Of those, 83 (20.7%) underwent further advanced clinical PCa evaluation with mpMRI and/or prostate biopsy due to elevated PSA and/or lowered PSA ratio and/or suspicious DRE. Logistic regression and binary regression tree models were applied to identify PCa in BOO patients. Results: An mpMRI was conducted in 56 (66%) of 83 patients and revealed PIRADS 4/5 lesions in 14 (25%) patients. Subsequently, a combined systematic randomized and MRI-fusion biopsy was performed in 19 (23%) patients and revealed in PCa detection in four patients (5%). A randomized prostate biopsy was performed in 31 (37%) patients and revealed in PCa detection in three patients (4%). All seven patients (9%) with PCa detection underwent radical prostatectomy with 29% exhibiting non-organ confined disease. Incidental PCa after HoLEP (n = 76) was found in nine patients (12%) with advanced clinical PCa evaluation preoperatively. In univariable logistic regression analyses, PSA, fPSA ratio, and PSA density failed to identify patients with PCa detection. Conversely, patients with a lower International Prostate Symptom Score (IPSS) and PIRADs 4/5 lesion in mpMRI were at higher risk for PCa detection. In multivariable adjusted analyses, PIRADS 4/5 lesions were confirmed as an independent risk factor (OR 9.91, p = 0.04), while IPSS did not reach significance (p = 0.052). Conclusion: In advanced clinical PCa evaluation mpMRI should be considered in patients with elevated total PSA or low fPSA ratio scheduled for BOO treatment with HoLEP. Patients with low IPSS or PIRADS 4/5 lesions in mpMRI are at highest risk for PCa detection. In patients with a history of two or more sets of negative prostate biopsies, advanced clinical PCa evaluation might be omitted.
Authors: W J Catalona; A W Partin; K M Slawin; M K Brawer; R C Flanigan; A Patel; J P Richie; J B deKernion; P C Walsh; P T Scardino; P H Lange; E N Subong; R E Parson; G H Gasior; K G Loveland; P C Southwick Journal: JAMA Date: 1998-05-20 Impact factor: 56.272
Authors: Mark Wu; Satheesh Krishna; Rebecca E Thornhill; Trevor A Flood; Matthew D F McInnes; Nicola Schieda Journal: J Magn Reson Imaging Date: 2019-01-30 Impact factor: 4.813
Authors: Santino S Butler; Vinayak Muralidhar; Shuang G Zhao; Nina N Sanford; Idalid Franco; Zoe H Fullerton; Janice Chavez; Anthony V D'Amico; Felix Y Feng; Timothy R Rebbeck; Paul L Nguyen; Brandon A Mahal Journal: Cancer Date: 2019-12-03 Impact factor: 6.860
Authors: Felix Preisser; Lena Theissen; Mike Wenzel; Clara Humke; Boris Bodelle; Jens Köllermann; Luis Kluth; Severine Banek; Andreas Becker; Frederik Roos; Felix K-H Chun; Philipp Mandel Journal: Eur Urol Focus Date: 2019-07-08
Authors: Veeru Kasivisvanathan; Antti S Rannikko; Marcelo Borghi; Valeria Panebianco; Lance A Mynderse; Markku H Vaarala; Alberto Briganti; Lars Budäus; Giles Hellawell; Richard G Hindley; Monique J Roobol; Scott Eggener; Maneesh Ghei; Arnauld Villers; Franck Bladou; Geert M Villeirs; Jaspal Virdi; Silvan Boxler; Grégoire Robert; Paras B Singh; Wulphert Venderink; Boris A Hadaschik; Alain Ruffion; Jim C Hu; Daniel Margolis; Sébastien Crouzet; Laurence Klotz; Samir S Taneja; Peter Pinto; Inderbir Gill; Clare Allen; Francesco Giganti; Alex Freeman; Stephen Morris; Shonit Punwani; Norman R Williams; Chris Brew-Graves; Jonathan Deeks; Yemisi Takwoingi; Mark Emberton; Caroline M Moore Journal: N Engl J Med Date: 2018-03-18 Impact factor: 176.079