Preoperative multiparametric prostate magnetic resonance imaging: a safe clinical practice to reduce incidental prostate cancer in Holmium laser enucleation of the prostate

Abstract

Introduction Purpose of the study was to investigate the correlation of a preoperative multiparametric magnetic resonance imaging of the prostate (mpMRI) in patients with a suspicion of prostate cancer and eligible for Holmium Laser Enucleation of the Prostate (HoLEP). Material and methods Data of 228 patients who had undergone HoLEP was selected and retrospectively analyzed from a multicentric database. All patients presented with a raised serum PSA and/or an abnormal digital rectal examination (DRE). Prostate cancer (PCa) was excluded either with a negative mpMRI (group ‘NEGATIVE MRI’ n = 113) or a standard biopsy (group ‘NO MRI’ n = 115). Preoperative characteristic surgical and histological outcomes were confronted. A univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa). Results Both groups presented with no statistical differences in preoperative characteristics besides previous acute urinary retention rates and post-voided residual volume, found to be higher (27.8% vs. 14.2% and median 120cc vs. 80cc) in NO MRI and NEGATIVE MRI respectively. No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. Statistically lower rate of iPCa (p = 0.03) was detected in the NEGATIVE MRI group (6.2%) in comparison with NO MRI group (14.8%). In multivariate logistic regression only presence of a preoperative negative mpMRI correlated (p = 0.04) as an independent predictive factor (OR 2.63; 95% CI: 1.02–6.75). Conclusions A negative mpMRI might be a useful tool to be included in a novel preoperative assessment to patients eligible for HoLEP with a suspicion of PCa in order to avoid an incidental PCa.

Incidental prostate cancer after holmium laser enucleation of the prostate—A narrative review

“…One compared HoLEP with both OP and TURP (Capogrosso et al, 2018). Regarding the quality of the studies, 52.6% of our studies were adequate/fair (Capogrosso et al, 2018;He et al, 2020;Herlemann et al, 2017;Kim et al, 2014;Martos et al, 2021;Nunez et al, 2011;Otsubo et al, 2015;Rivera et al, 2014;Rosenhammer et al, 2018b;Tominaga et al, 2019), 36.8% good Elkoushy et al, 2015;Ohwaki et al, 2017;Porreca et al, 2019Porreca et al, , 2020Rosenhammer et al, 2018a;Wenzel et al, 2021) and 10.6% strong quality (Bhojani et al, 2015;Magistro et al, 2020).…”

“…Three studies compared HoLEP with TURP (He et al, 2020;Herlemann et al, 2017;Rosenhammer et al, 2018a) and another compared HoLEP with OP (Rosenhammer et al, 2018b). Instead of drawing comparisons with other treatment approaches, other studies reported HoLEP's oncological and functional outcomes (Nunez et al, 2011;Rivera et al, 2014;Tominaga et al, 2019), the role of imaging modalities in detecting iPCa (Kim et al, 2014;Porreca et al, 2019Porreca et al, , 2020Wenzel et al, 2021), the predictive factors of iPCa after HoLEP (Bhojani et al, 2015;Elkoushy et al, 2015;Ohwaki et al, 2017) and the role of PSA kinetics in detecting iPCa after HoLEP Magistro et al, 2020;Martos et al, 2021;Otsubo et al, 2015). We collated iPCa after HoLEP management strategies from the studies we reviewed, and summarise them below.…”

“…Porreca et al investigated the association between preoperative negative multiparametric magnetic resonance imaging (mpMRI) and iPCa rates in patients who underwent HoLEP (Porreca et al, 2019) and found that iPCa was detected in 24 (10.5%) patients overall. They identified a statistically lower rate of iPCa in patients with negative MRI compared to patients with no MRI (6.2% vs.…”

Surgical blood loss during holmium laser enucleation of the prostate (HoLEP) is not affected by short-term pretreatment with dutasteride: a double-blind placebo-controlled trial on prostate vascularity

“…They found that the space between prostate capsule and adenoma was less demarcated and it was more challenging looking at the correct surgical plane. Furthermore, even though it was not a primary endpoint, a total of 28 incidental prostate cancers were reported after histologic evaluation, 15 in the Group A and 13 in the Group B [24,25]. Looking at early complications, up to 30 days post-surgery, we found 11 PSA: prostate specific antigen; TT: total testosterone; DHT: dihydrotestosterone; SD: standard deviation.…”

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

“…The outcomes of radiotherapy after HoLEP need further study. 62 Gellhaus et al reported that only 27% of patients who underwent robotic-assisted laparoscopic prostatectomy after HoLEP developed with UI. Other oncologic parameters like the positive margin and the biochemical recurrence rate were similar to patients without a previous history of BPH surgery.…”