ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 February;71(1):72-8

DOI: 10.23736/S0393-2249.18.03186-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Role of Holmium laser enucleation of the prostate to increase cancer detection rate in patients with gray-zone PSA level

Ki H. KIM ¹, Sang W. KIM ², Hee S. SON ², Dae K. KIM ³, Dae C. JUNG ⁴, Hyun W. KIM ⁵, Joon C. KIM ⁶, Sung J. HONG ², Jang H. KIM ² ✉

¹ Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, South Korea; ² Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea; ³ Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, South Korea; ⁴ Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea; ⁵ Department of Urology, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; ⁶ Department of Urology, Bucheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Bucheon, South Korea

BACKGROUND: Even though the safety of the treatment for prostate cancer diagnosed by HoLEP has been reported, the diagnostic value of HoLEP for prostate cancer detection has not been confirmed. Therefore, we investigated the diagnostic potential of HoLEP for detecting prostate cancer.
METHODS: Between December 2009 and October 2015, 359 patients (median age, 70.9 years; range, 66.2-74.8) were treated simultaneously with HoLEP and transrectal prostate needle biopsy (TPNB). Of these, 199 patients with a normal digital rectal examination and serum PSA concentration between 3.5 and 10.0 ng/mL were included in the study. Univariate and multivariate logistic regression analyses were performed to identify the predictive factor for prostate cancer detected by HoLEP.
RESULTS: Median PSA, prostate volume and PSA density were 4.97 ng/mL (range, 4.20-6.70), 57.40 gm (range, 43.67-77.80) and 0.09 ng/mL2 (range, 0.07-0.12), respectively. Prostate cancer (Gleason score ≥6) was detected in 46 cases (23.1%). Of these, 26 (56.5%) were detected by HoLEP pathology, 11 (23.9%) by TPNB pathology, and 9 (19.6%) by both. Univariate and multivariate logistic regression analyses were performed in 179 patients, including benign prostatic hyperplasia patients (N=153, 76.9%) and patients with cancer detected by HoLEP pathology. PSA density was identified as an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA.
CONCLUSIONS: HoLEP is a viable modality for detecting prostate cancer in selected cases. PSA density was an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA.

KEY WORDS: Lasers, solid-state - Prostate-specific antigen - Prostatic neoplasms