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The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates.
World J Urol. 2020 Jun 25 [Online ahead of print]WJ

Abstract

PURPOSE

To evaluate the diagnostic value of a high preoperative PSA level for the detection of incidental prostate cancer (iPCa) in LUTS patients with very large prostates (> 100 cc).

METHODS

We conducted a retrospective analysis of 1125 men treated for LUTS with holmium laser enucleation of the prostate (HoLEP). Patients were stratified according to a preoperative PSA level higher (high PSA; n = 365) or lower than 10 ng/ml (low PSA; n = 760). Preoperative and histopathological parameters were compared between both cohorts. Logistic regression models were used to identify independent predictors of iPCa.

RESULTS

Demographic parameters were similar between both cohorts. The median PSA levels were 14.2 ng/ml (11.5-19.9) and 4 ng/ml (2.4-6.0). The prostate volume was significantly higher in the high PSA group (105 cc vs. 75 cc; p < 0.001). Correspondingly, the PSA density was significantly increased in the high PSA cohort compared to the low PSA cohort (0.14 vs. 0.05; p < 0.001). The overall detection rate of iPCa showed no difference between groups (9.5% vs. 9.9%). More preoperative prostate biopsies were performed in the high PSA group compared to the low PSA group (46.8% vs. 17.6%; p < 0.001). However, the rate of false negative results was comparable between groups (12.7% vs. 11.1%; p = 0.726). In logistic regression models all PSA-related parameters failed to predict iPCa.

CONCLUSIONS

PSA-guided approaches to predict iPCa in LUTS patients with very large prostates are not accurate. This finding is useful in clinical practice for counselling our patients and to prevent unwarranted diagnostic procedures.

Authors+Show Affiliations

Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. Giuseppe.Magistro@med.uni-muenchen.de.Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32588205

Citation

Magistro, Giuseppe, et al. "The Significance of a High Preoperative PSA Level for the Detection of Incidental Prostate Cancer in LUTS Patients With Large Prostates." World Journal of Urology, 2020.
Magistro G, Keller P, Westhofen T, et al. The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates. World J Urol. 2020.
Magistro, G., Keller, P., Westhofen, T., Schott, M., Tamalunas, A., Weinhold, P., & Stief, C. G. (2020). The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates. World Journal of Urology. https://doi.org/10.1007/s00345-020-03321-w
Magistro G, et al. The Significance of a High Preoperative PSA Level for the Detection of Incidental Prostate Cancer in LUTS Patients With Large Prostates. World J Urol. 2020 Jun 25; PubMed PMID: 32588205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates. AU - Magistro,Giuseppe, AU - Keller,Patrick, AU - Westhofen,Thilo, AU - Schott,Melanie, AU - Tamalunas,Alexander, AU - Weinhold,Philipp, AU - Stief,Christian G, Y1 - 2020/06/25/ PY - 2020/04/01/received PY - 2020/06/16/accepted PY - 2020/6/27/entrez KW - Benign prostatic hyperplasia KW - Holmium laser enucleation of the prostate (HoLEP) KW - Incidental prostate cancer KW - Lower urinary tract symptoms JF - World journal of urology JO - World J Urol N2 - PURPOSE: To evaluate the diagnostic value of a high preoperative PSA level for the detection of incidental prostate cancer (iPCa) in LUTS patients with very large prostates (> 100 cc). METHODS: We conducted a retrospective analysis of 1125 men treated for LUTS with holmium laser enucleation of the prostate (HoLEP). Patients were stratified according to a preoperative PSA level higher (high PSA; n = 365) or lower than 10 ng/ml (low PSA; n = 760). Preoperative and histopathological parameters were compared between both cohorts. Logistic regression models were used to identify independent predictors of iPCa. RESULTS: Demographic parameters were similar between both cohorts. The median PSA levels were 14.2 ng/ml (11.5-19.9) and 4 ng/ml (2.4-6.0). The prostate volume was significantly higher in the high PSA group (105 cc vs. 75 cc; p < 0.001). Correspondingly, the PSA density was significantly increased in the high PSA cohort compared to the low PSA cohort (0.14 vs. 0.05; p < 0.001). The overall detection rate of iPCa showed no difference between groups (9.5% vs. 9.9%). More preoperative prostate biopsies were performed in the high PSA group compared to the low PSA group (46.8% vs. 17.6%; p < 0.001). However, the rate of false negative results was comparable between groups (12.7% vs. 11.1%; p = 0.726). In logistic regression models all PSA-related parameters failed to predict iPCa. CONCLUSIONS: PSA-guided approaches to predict iPCa in LUTS patients with very large prostates are not accurate. This finding is useful in clinical practice for counselling our patients and to prevent unwarranted diagnostic procedures. SN - 1433-8726 UR - https://www.unboundmedicine.com/medline/citation/32588205/The_significance_of_a_high_preoperative_PSA_level_for_the_detection_of_incidental_prostate_cancer_in_LUTS_patients_with_large_prostates L2 - https://dx.doi.org/10.1007/s00345-020-03321-w DB - PRIME DP - Unbound Medicine ER -
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