Predictors of Unfavorable Pathology in Patients with Incidental (pT1a-T1b) Prostate Cancer.

Incidental prostate cancer (IPCa) is encountered in 10% of surgical procedures for benign prostatic obstruction (BPO). Identification of patients with underlying detrimental prostate cancer is paramount for tailored treatment decision-making, but guideline recommendations for this setting are lacking.

To highlight clinical and histological characteristics related to BPO surgery that may predict IPCa with unfavorable pathology.

We included men with IPCa who underwent radical prostatectomy (RP) in the short term after IPCa diagnosis. Two cohorts were built according to final pathology for the RP specimen: unfavorable pathology (International Society of Urological Pathology [ISUP] grade group [GG] ≥3 and/or ≥pT3a and/or pN1) versus favorable pathology.

We performed multivariate regression analysis for the endpoint, which was unfavorable pathology for the RP specimen. Using the model estimates for prostate-specific antigen (PSA), ISUP GG, age, and prostate volume, we established a model for estimating the risk of unfavorable histopathology.

Overall, 112 patients were included in the final assessment. On multivariate analysis, PSA (odds ratio [OR] 1.083, 95% confidence interval [CI] 1.003-1.170; p = 0.042), ISUP GG for the specimen from BPO surgery (OR 3.090; 95% CI 1.129-8.457; p = 0.028), and age (OR 1.121, 95% CI 1.026-1.225; p = 0.012) were independent predictors for unfavorable histopathology. On receiver operating characteristic analysis, the area under the curve was 0.751. A novel calculator was developed to predict adverse pathology for men with IPCa. The study is limited by its retrospective design.

For men with IPCa, PSA before surgery for BPO, ISUP GG, and age are independent predictors of unfavorable disease. Our results might improve preoperative risk assessment for patient counseling.

We developed a novel calculator to estimate the risk of underlying detrimental disease in men diagnosed with prostate cancer at surgery for benign prostatic obstruction.

European urology focus. 2022 Mar 19 [Epub ahead of print]

Igor Tsaur, Roderick C N van den Bergh, Timo Soeterik, Anita Thomas, Maximilian P Brandt, Fabio Zattoni, Fabrizio Dal Moro, Alessandro Morlacco, Jeanlou Collavino, Guillaume Ploussard, Christian Surcel, Christian Mirvald, Orel Carmona, Barak Rosenzweig, Christian Ruckes, Tatjana Heisinger, Isabel Heidegger, Giorgio Gandaglia, Robert Dotzauer, European Association of Urology Young Academic Urologists Prostate Cancer Working Party

Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany. Electronic address: ., Department of Urology, St Antonius Hospital, Utrecht, The Netherlands., Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany., Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padua, Padua, Italy., Department of Urology, La Croix du Sud Hospital, Toulouse, France; Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France., Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania., Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel., Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Interdisciplinary Centre for Clinical Trials, University Medical Centre, Johannes Gutenberg University, Mainz, Germany., Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.

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