Multiparametric MRI may help to identify patients with prostate cancer in a contemporary cohort of patients with clinical bladder outlet obstruction scheduled for holmium laser enucleation of the prostate (HoLEP)

  • 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.
Author:Mike WenzelORCiDGND, Maria-Noemi WelteGND, Lina Grossmann, Felix Martin PreißerORCiDGND, Lena Hermine TheißenORCiDGND, Clara Julia HumkeGND, Marina Deuker, Simon BernatzORCiDGND, Philipp Gild, Sascha Ahyai, Pierre I. Karakiewicz, Boris BodelleORCiDGND, Luis A. KluthORCiDGND, Felix ChunORCiDGND, Philipp MandelORCiDGND, Andreas BeckerGND
Parent Title (English):Frontiers in Surgery
Publisher:Frontiers Media
Place of publication:Lausanne
Document Type:Article
Date of Publication (online):2021/02/25
Date of first Publication:2021/02/25
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2021/05/17
Tag:BPH; BPO; HOLEP; IPSS; PSA; fusion biopsy; systematic biopsy
Issue:art. 633196
Page Number:8
First Page:1
Last Page:8
Copyright © 2021 Wenzel, Welte, Grossmann, Preisser, Theissen, Humke, Deuker, Bernatz, Gild, Ahyai, Karakiewicz, Bodelle, Kluth, Chun, Mandel and Becker. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0