nach oben

Erschienen in:

17.05.2017 | Original Article

“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)

verfasst von: Annika Herlemann, Kerstin Wegner, Alexander Roosen, Alexander Buchner, Philipp Weinhold, Alexander Bachmann, Christian G. Stief, Christian Gratzke, Giuseppe Magistro

Erschienen in: World Journal of Urology | Ausgabe 11/2017

Einloggen, um Zugang zu erhalten

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.

Gravas S et al (2015) Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. Benign prostatic obstruction (BPO). https://uroweb.org/wp-content/uploads/EAU-Guidelines-Non-Neurogenic-Male-LUTS-Guidelines-2015-v2.pdf

Gilling PJ et al (2012) Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int 109(3):408–411CrossRefPubMed

Lourenco T et al (2008) Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials. BMJ 337:a449CrossRefPubMed

Tan A et al (2007) Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg 94(10):1201–1208CrossRefPubMed

Yin L et al (2013) Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol 27(5):604–611CrossRefPubMed

Elmansy H et al (2012) Holmium laser enucleation versus photoselective vaporization for prostatic adenoma greater than 60 ml: preliminary results of a prospective, randomized clinical trial. J Urol 188(1):216–221CrossRefPubMed

Elmansy HM, Kotb A, Elhilali MM (2011) Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup. J Urol 186(5):1972–1976CrossRefPubMed

Krambeck AE, Handa SE, Lingeman JE (2013) Experience with more than 1000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 189(1 Suppl):S141–S145CrossRefPubMed

Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53(1):160–166CrossRefPubMed

10.

Tooher R et al (2004) A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia. J Urol 171(5):1773–1781CrossRefPubMed

11.

van Rij S, Gilling PJ (2012) In 2013, holmium laser enucleation of the prostate (HoLEP) may be the new ‘gold standard’. Curr Urol Rep 13(6):427–432CrossRefPubMed

12.

Gratzke C et al (2015) EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 67(6):1099–1109CrossRefPubMed

13.

Mottet N et al (2015) Guidelines on Prostate Cancer; European Association of Urology 2015. http://uroweb.org/wp-content/uploads/09-Prostate-Cancer_LR.pdf

14.

Nunez R et al (2011) Incidental prostate cancer revisited: early outcomes after holmium laser enucleation of the prostate. Int J Urol 18(7):543–547CrossRefPubMed

15.

Naspro R et al (2004) Holmium laser enucleation versus transurethral resection of the prostate. Are histological findings comparable? J Urol 171(3):1203–1206CrossRefPubMed

16.

Kim M et al (2014) Prostate cancer detected after Holmium laser enucleation of prostate (HoLEP): significance of transrectal ultrasonography. Int Urol Nephrol 46(11):2079–2085CrossRefPubMed

17.

Bhojani N et al (2015) Coexisting prostate cancer found at the time of holmium laser enucleation of the prostate for benign prostatic hyperplasia: predicting its presence and grade in analyzed tissue. J Endourol 29(1):41–46CrossRefPubMed

18.

Rivera ME et al (2014) Holmium laser enucleation of the prostate and perioperative diagnosis of prostate cancer: an outcomes analysis. J Endourol 28(6):699–703CrossRefPubMed

19.

Sakamoto H et al (2014) Preoperative parameters to predict incidental (T1a and T1b) prostate cancer. Can Urol Assoc J 8(11–12):E815–E820CrossRefPubMedPubMedCentral

20.

Otto B et al (2014) Incidental prostate cancer in transurethral resection of the prostate specimens in the modern era. Adv Urol 2014:627290CrossRefPubMedPubMedCentral

21.

Voigt S et al (2011) Risk factors for incidental prostate cancer-who should not undergo vaporization of the prostate for benign prostate hyperplasia? Prostate 71(12):1325–1331PubMed

22.

Melchior S et al (2009) Outcome of radical prostatectomy for incidental carcinoma of the prostate. BJU Int 103(11):1478–1481CrossRefPubMed

23.

Argyropoulos A et al (2005) Characteristics of patients with stage T1b incidental prostate cancer. Scand J Urol Nephrol 39(4):289–293CrossRefPubMed

24.

Jones JS, Follis HW, Johnson JR (2009) Probability of finding T1a and T1b (incidental) prostate cancer during TURP has decreased in the PSA era. Prostate Cancer Prostatic Dis 12(1):57–60CrossRefPubMed

25.

Elkoushy MA, Elshal AM, Elhilali MM (2015) Incidental prostate cancer diagnosis during holmium laser enucleation: assessment of predictors, survival, and disease progression. Urology 86(3):552–557CrossRefPubMed

26.

Benson MC et al (1993) An algorithm for prostate cancer detection in a patient population using prostate-specific antigen and prostate-specific antigen density. World J Urol 11(4):206–213CrossRefPubMed

27.

Carter HB et al (2006) Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst 98(21):1521–1527CrossRefPubMedPubMedCentral

28.

Ciatto S et al (2001) Predicting prostate biopsy outcome by findings at digital rectal examination, transrectal ultrasonography, PSA, PSA density and free-to-total PSA ratio in a population-based screening setting. Int J Biol Markers 16(3):179–182PubMed

29.

Helfand BT et al (2009) Postoperative PSA and PSA velocity identify presence of prostate cancer after various surgical interventions for benign prostatic hyperplasia. Urology 74(1):177–183CrossRefPubMed

30.

Kuriyama M et al (1999) Determination of reference values for total PSA, F/T and PSAD according to prostatic volume in japanese prostate cancer patients with slightly elevated serum PSA levels. Jpn J Clin Oncol 29(12):617–622CrossRefPubMed

31.

Stephan C et al (2002) Multicenter evaluation of an artificial neural network to increase the prostate cancer detection rate and reduce unnecessary biopsies. Clin Chem 48(8):1279–1287PubMed

32.

Michalak J, Tzou D, Funk J (2015) HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol 3(1):36–42PubMedPubMedCentral

33.

Stephan C et al (2005) The ratio of prostate-specific antigen (PSA) to prostate volume (PSA density) as a parameter to improve the detection of prostate carcinoma in PSA values in the range of <4 ng/mL. Cancer 104(5):993–1003CrossRefPubMed

34.

Delongchamps NB, Portalez D, Bruguière E, Rouvière O, Malavaud B, Mozer P, Fiard G, Cornud F, MURIELLE Study Group (2016) Are MRI-TRUS-guided targeted biopsies non-inferior to TRUS-guided systematic biopsies for the detection of prostate cancer in patients with a single suspicious focus on multiparametric prostate MRI? Results of a multicentric controlled trial. J Urol 196(4):1069–1075. doi:10.1016/j.juro.2016.04.003 CrossRefPubMed

Titel: “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)
verfasst von: Annika Herlemann
Kerstin Wegner
Alexander Roosen
Alexander Buchner
Philipp Weinhold
Alexander Bachmann
Christian G. Stief
Christian Gratzke
Giuseppe Magistro
Publikationsdatum: 17.05.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 11/2017
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2048-y

Neu im Fachgebiet Urologie

25.04.2024 | Nierenkarzinom | Nachrichten

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

“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)

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Stufenschema weist Prostatakarzinom zuverlässig nach

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Urologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2017

Factors that influence lower urinary tract symptom (LUTS)-related quality of life (QoL) in a healthy population

Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?

Understanding patients’ preferences for surgical management of urethral stricture disease

Transrectal ultrasound guided prostate biopsy in the era of increasing fluoroquinolone resistance: prophylaxis with single-dose ertapenem

The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stent-related symptoms: a systematic review and meta-analysis

Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Stufenschema weist Prostatakarzinom zuverlässig nach

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Urologie