"Finding the needle in a haystack": oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP).

Title "Finding the needle in a haystack": oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP).
Authors A. Herlemann; K. Wegner; A. Roosen; A. Buchner; P. Weinhold; A. Bachmann; C.G. Stief; C. Gratzke; G. Magistro
Journal World J Urol
DOI 10.1007/s00345-017-2048-y
Abstract

PURPOSE: To evaluate oncologic parameters of men with bothersome LUTS undergoing surgical treatment with HoLEP or TURP.

METHODS: Five hundred and eighteen patients undergoing HoLEP (n = 289) or TURP (n = 229) were retrospectively analyzed for total PSA, prostate volume, PSA density, history of prostate biopsy, resected prostate weight, and histopathological features. Univariate and multivariate logistic regression models were used to identify independent predictors of incidental PCa (iPCa).

RESULTS: Men undergoing HoLEP had a significantly higher total PSA (median 5.5 vs. 2.3 ng/mL) and prostate volume (median 80 vs. 41 cc), and displayed a greater reduction of prostate volume after surgery compared to TURP patients (median 71 vs. 50%; all p < 0.001). With a prevalence of incidental PCa (iPCa) of 15 and 17% for HoLEP and TURP, respectively, the choice of procedure had no influence on the detection of iPCa (p = 0.593). However, a higher rate of false-negative preoperative prostate biopsies was noted among iPCa patients in the HoLEP arm (40 vs. 8%, p = 0.007). In multivariate logistic regression, we identified patient age (OR 1.04; 95% CI 1.01-1.07, p = 0.013) and PSA density (OR 2.13; 95% CI 1.09-4.18, p = 0.028) as independent predictors for the detection of iPCa.

CONCLUSIONS: Despite differences in oncologic parameters, the choice of technique had no influence on the detection of iPCa. Increased patient age and higher PSA density were associated with iPCa. A higher rate of false-negative preoperative prostate biopsies was noted in HoLEP patients. Therefore, diagnostic assessment of LUTS patients requires a more adapted approach to exclude malignancy, especially in those with larger prostates.

Citation A. Herlemann; K. Wegner; A. Roosen; A. Buchner; P. Weinhold; A. Bachmann; C.G. Stief; C. Gratzke; G. Magistro."Finding the needle in a haystack": oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP).. World J Urol. 2017. doi:10.1007/s00345-017-2048-y

Related Elements

Holmium

See more Holmium products. Holmium (atomic symbol: Ho, atomic number: 67) is a Block F, Group 3, Period 6 element with an atomic radius of 164.93032. Holmium Bohr ModelThe number of electrons in each of Holmium's shells is [2, 8, 18, 29, 8, 2] and its electron configuration is [Xe] 4f11 6s2. Elemental Holmium PictureThe holmium atom has a radius of 176 pm and its Covalent radius is 192±7 pm. Holmium was first discovered by Marc Delafontaine in 1878. In its elemental form, holmium has a silvery white appearance. It is relatively soft and malleable. It is stable in dry air at room temperature but rapidly oxidizes at elevated temperatures and in moist air. Holmium has unusual magnetic properties. Its name is derived from the Latin word Holmia meaning Stockholm.