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“Finding the needle in a haystack”: oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP)

World Journal of Urology volume 35, pages 1777–1782 (2017)Cite this article

Abstract

Purpose

To evaluate oncologic parameters of men with bothersome LUTS undergoing surgical treatment with HoLEP or TURP.

Methods

Five hundred and eighteen patients undergoing HoLEP (n = 289) or TURP (n = 229) were retrospectively analyzed for total PSA, prostate volume, PSA density, history of prostate biopsy, resected prostate weight, and histopathological features. Univariate and multivariate logistic regression models were used to identify independent predictors of incidental PCa (iPCa).

Results

Men undergoing HoLEP had a significantly higher total PSA (median 5.5 vs. 2.3 ng/mL) and prostate volume (median 80 vs. 41 cc), and displayed a greater reduction of prostate volume after surgery compared to TURP patients (median 71 vs. 50%; all p < 0.001). With a prevalence of incidental PCa (iPCa) of 15 and 17% for HoLEP and TURP, respectively, the choice of procedure had no influence on the detection of iPCa (p = 0.593). However, a higher rate of false-negative preoperative prostate biopsies was noted among iPCa patients in the HoLEP arm (40 vs. 8%, p = 0.007). In multivariate logistic regression, we identified patient age (OR 1.04; 95% CI 1.01–1.07, p = 0.013) and PSA density (OR 2.13; 95% CI 1.09–4.18, p = 0.028) as independent predictors for the detection of iPCa.

Conclusions

Despite differences in oncologic parameters, the choice of technique had no influence on the detection of iPCa. Increased patient age and higher PSA density were associated with iPCa. A higher rate of false-negative preoperative prostate biopsies was noted in HoLEP patients. Therefore, diagnostic assessment of LUTS patients requires a more adapted approach to exclude malignancy, especially in those with larger prostates.

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Author information

Affiliations

  1. Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Annika Herlemann, Kerstin Wegner, Alexander Buchner, Philipp Weinhold, Christian G. Stief, Christian Gratzke & Giuseppe Magistro

  2. Department of Urology, Augusta-Kranken-Anstalt gGmbH, Bochum, Germany

    Alexander Roosen

  3. alta uro AG, Basel, Switzerland

    Alexander Bachmann

Authors
  1. Annika Herlemann
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  2. Kerstin Wegner
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  3. Alexander Roosen
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  4. Alexander Buchner
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  5. Philipp Weinhold
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  6. Alexander Bachmann
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  7. Christian G. Stief
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  8. Christian Gratzke
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  9. Giuseppe Magistro
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Contributions

A. Herlemann: data collection and analysis, and manuscript writing. K. Wegner: data collection and management, and data analysis. A. Roosen: project development and data collection. A. Buchner: data collection and analysis, and manuscript writing. P. Weinhold: data collection and management. A. Bachmann: data collection and management. CG. Stief: Project development, and data collection and management. C. Gratzke: Project development, and data collection and management. G. Magistro: Project development, data collection and analysis, and manuscript writing.

Corresponding author

Correspondence to Giuseppe Magistro.

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Herlemann, A., Wegner, K., Roosen, A. et al. “Finding the needle in a haystack”: oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP). World J Urol 35, 1777–1782 (2017). https://doi.org/10.1007/s00345-017-2048-y

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  • DOI: https://doi.org/10.1007/s00345-017-2048-y

Keywords

  • Benign prostatic hyperplasia
  • Incidental prostate cancer
  • Holmium laser enucleation of the prostate
  • Transurethral resection of the prostate
  • PSA density