Incidental prostate cancer (IPC) is not uncommon in patients undergoing surgery for benign prostate enlargement (BPE). However, the associated risk factors remain incompletely understood. This study aimed to evaluate potential clinical predictors of IPC.
A systematic search of MEDLINE, Embase, and Web of Science was conducted in January 2025 to identify studies assessing risk factors for IPC. Pairwise meta-analyses were performed using a random-effects model, pooling adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable analyses. Risk of bias was evaluated using the ROBINS-I tool. (PROSPERO: CRD42024588776).
Twenty-five studies comprising 247,966 patients were included. IPC was identified in 6,748 patients, with reported rates ranging from 2.2% to 49.6%. Significant risk factors for IPC included: Elevated PSA level (OR: 1.03; 95% CI: 1.01-1.05; p = 0.01), PSA density >0.15 ng/mL/cc (OR: 3.02; 95% CI: 1.50-6.07; p = 0.01), Older age (OR: 1.05; 95% CI: 1.01-1.08; p = 0.01), and Higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02-1.18; p = 0.01). Prostate volume, diabetes, and dyslipidemia were not associated with IPC risk. Notably, use of 5-alpha reductase inhibitors (5-ARIs) was linked to a significantly reduced risk (OR: 0.53; 95% CI: 0.33-0.85; p = 0.01). Study limitations included heterogeneity across studies, retrospective designs, and incomplete reporting of key variables.
Elevated PSA, high PSA density, older age, and increased BMI were associated with a higher risk of IPC in patients undergoing surgery for BPE. Conversely, preoperative use of 5-ARIs was associated with a reduced risk. These findings may support improved preoperative risk stratification and help identify patients in whom additional diagnostic evaluations could be considered or avoided. Further research is needed to better define predictors of clinically significant IPC.
Prostate cancer and prostatic diseases. 2026 Mar 23 [Epub ahead of print]
Angelo Cormio, Akihiro Matsukawa, Alessandro Dematteis, Ahmed R Alfarhan, Marcin Miszczyk, Navid Roessler, Abdulrahman S Alqahtani, Stefano Mancon, Ichiro Tsuboi, Paweł Rajwa, Ugo Giovanni Falagario, Francesca Sanguedolce, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio, Andrea Benedetto Galosi, David D'Andrea, Takahiro Kimura, Shahrokh F Shariat
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. ., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, Foggia, Italy., Pathology Unit, Policlinico Foggia, University of Foggia, Foggia, Italy., Department of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.