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Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis

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Abstract

Introduction

This systematic review aims at reporting the incidence, predictive factors, and the oncological outcomes of incidental prostate cancer (IPCa) in men who underwent endoscopic enucleation of prostate (EEP).

Methods

A literature search was performed using the following Medical Subject Heading (MeSH) terms and keywords: “Prostatic Neoplasms”, “Prostate Cancer”, “Transurethral Resection of Prostate”, “Prostate resection”, “Prostate enucleation”. Meta-analysis was performed if there were two or more studies reporting the same outcome under the same definition. In case of insufficient data, results were presented in a narrative manner.

Results

Sixty-one studies were included in qualitative synthesis and 55 were included in meta-analysis. The pooled IPCa rate was 0.08 (95% CI 0.073–0.088). Increasing age, higher preoperative serum prostate-specific antigen (PSA) level, higher preoperative PSA density (PSAD), smaller prostate volume, higher postoperative PSA velocity and lower enucleated prostate weight, were reported to have significant correlation with IPCa. In BPH patients, the mean pre-operative and post-operative PSA levels were 5.58 ± 1.48 ng/dL and 1.06 ± 0.27 ng/dL, respectively. In patients with IPCa, the mean pre-operative and post-operative PSA levels were 7.72 ± 2.90 ng/dL and 2.77 ± 1.66 ng/dL, respectively. The mean percentage PSA reduction was 82.0% ± 1.8% for BPH patients and 68.2% ± 12.1% for IPCa patients. IPCa was most commonly managed by active surveillance (68.7%).

Conclusions

The pooled incidence of IPCa after EEP was 8%. An absolute post-operative PSA level of < 2.0 and a percentage PSA reduction of > 70% should be expected in BPH patients after EEP.

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Authors and Affiliations

  1. Department of Surgery, United Christian Hospital, Hong Kong, China

    Bryan Kwun-Chung Cheng

  2. Department of Urology, University Hospital “Ospedali Riuniti” and Polytechnic University of Marche Region, Ancona, Italy

    Daniele Castellani

  3. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Ivan Sik-Hei Chan, Abu Baker, Vinson Wai-Shun Chan, Chi-Fai Ng & Jeremy Yuen-Chun Teoh

  4. Department of Urology, Ng Teng Fong General Hospital, NUHS, Jurong East, Singapore

    Vineet Gauhar

  5. Hospital Israelita Albert Einstein, Sao Paulo, Brazil

    Marcelo Langer Wroclawski

  6. BP-a Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil

    Marcelo Langer Wroclawski

  7. Hospital Covadonga, Corporativo De Hospitalea S.A. de C.V., Córdoba, Mexico

    Hegel Trujillo Santamaria

  8. Department of Urology, Marmara University School of Medicine, İstanbul, Turkey

    Yiloren Tanidir

  9. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Dmitry Enikeev

  10. Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas Herrmann

  11. Department of Urology, Hanover Medical School (MHH), Hanover, Germany

    Thomas Herrmann

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  1. Bryan Kwun-Chung Cheng
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Correspondence to Bryan Kwun-Chung Cheng or Jeremy Yuen-Chun Teoh.

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Cheng, B.KC., Castellani, D., Chan, I.SH. et al. Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol 40, 87–101 (2022). https://doi.org/10.1007/s00345-021-03756-9

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