Ersin GÖKMEN, Türker ALTUNTAŞ, Bahadır Kağan KALYONCU, Hamza Tunahan MİDİLLİ, Günal ÖZGÜR, Murat KARS, Tarık Emre ŞENER
Bulletin of Urooncology - 2026;25(2):53-58
Objective: To evaluate the predictive value of demographic, preoperative, and postoperative clinical parameters for detecting incidental prostate cancer (iPCa) in patients undergoing holmium laser enucleation of the prostate (HoLEP). Materials and Methods: Clinical records of male patients who underwent HoLEP for BPH between 01.01.2023 and 01.01.2024 were retrospectively reviewed. Demographic, preoperative, and postoperative data, including total prostate-specific antigen (PSA), free PSA, and PSA density (PSAd), were analysed. The role of these measurements and data in predicting the likelihood of iPCa in patients whose pathology results revealed iPCa were evaluated. Results: A total of 112 patients underwent HoLEP , including 96 with BPH (85.7%) (group 1) and 16 with iPCa (Group 2) (14.3%). Median age was 66.5 years. Demographic data and PSA levels were comparable between groups. PSAd was significantly higher in Group 2 (0.06 vs. 0.04 ng/mL/cc, p=0.008), and PSAd >=0.15 was more frequent in Group 2 (25% vs. 5.2%, p=0.023). Pathology revealed 68.7% Gleason grade group 1, all under active surveillance, and 31.3% grade group 2-5, treated with radiotherapy +/- hormonal therapy. Multivariate analysis identified PSAd as the only independent predictor of iPCa (odds ratio: 9.09, 95% confidence interval: 1.12-73.8, p=0.01). Receiver operating characteristic analysis showed moderate diagnostic performance for PSAd (AUC: 0.71), with a 0.08 ng/mL/cc threshold yielding 75% sensitivity and 69.7% specificity. Conclusion: iPCa after HoLEP is relatively common but mostly low-grade, with favourable oncological outcomes. Preoperative PSAd was identified as a significant predictor of iPCa. These findings may aid in preoperative patient counselling and risk-stratified management. Active surveillance appears safe and effective for low-grade iPCa.
