Risk factors for incidental prostate cancer-who should not undergo vaporization of the prostate for benign prostate hyperplasia?

BACKGROUND Vaporization of the prostate (e.g., using laser devices) for treatment of benign prostatic hyperplasia does not allow for subsequent histological examination. Therefore, patients should be counseled about the risk of missing an incidental prostate cancer (incPCa). In this study the risk of an incPCa was determined based on all preoperative parameters. METHODS Thousand three hundred and fifty seven (04/2004–09/2008) patients underwent transurethral resection of the prostate (TURP) in our department. Cases with less than 10 g removed tissue, PSA >20 ng/ml or with known PCa were excluded. Data of the remaining 1,000 consecutive patients were collected retrospectively and statistically analyzed using SAS. RESULTS Mean age was 69.4 (36–96) years, mean PSA 4.41 (0.08–19.5) ng/ml, mean weight of removed tissue 30.9 (10–110) g. An incPCa was detected in 111 cases. Thirty‐four out of these were considered to be clinically relevant (relPCa; stage T1b and/or Gleason sum ≥7). In univariate analysis age, volume of the prostate and body mass index correlated with incPCa while age, volume of the prostate and PSA correlated with relPCa. Predictive parameters for a multivariate logistic regression model are age and body mass index for incPCa and age, prostate volume, and number of prior biopsies for relPCa. CONCLUSIONS More than 1 in 10 patients undergoing TURP has an incPCa and 3.4% have a relPCa. Patients should be counseled carefully about the risk of missing especially relPCa when undergoing vaporization of the prostate. Our model significantly improves prediction of relPCa compared to PSA and digital examination alone. Prostate 71:1325–1331, 2011. © 2011 Wiley‐Liss, Inc.