title: Prostate cancer detected after Holmium laser enucleation of prostate (HoLEP): significance of transrectal ultrasonography.
abstract: OBJECTIVE
  To identify predictors of incidental prostate cancer following Holmium laser enucleation of the prostate (HoLEP).
  
  
  METHODS
  We retrospectively analyzed 458 consecutive patients who underwent HoLEP. Patients were classified into two groups: patients who received prostate biopsy prior to HoLEP (biopsy group, n = 174) and patients who did not (non-biopsy group, n = 284). The two groups were compared. Logistic regression analysis was performed to determine the predictive factors.
  
  
  RESULTS
  A total of 27 patients (5.9 %) were incidentally diagnosed with prostate cancer. The incidence of prostate cancer was not significantly different between the two groups (biopsy group vs. non-biopsy group: 6.9 vs. 5.3 %, p = 0.48). Using multivariate analysis, a hypoechoic lesion identified by transrectal ultrasonography (TRUS) was the only predictor of incidental prostate cancer (odds ratio 2.829; 95 % confidence interval 1.061-7.539; p = 0.038). In the biopsy group, there were no significant differences in baseline characteristics including prostate size, prostate-specific antigen (PSA), PSA density, digital rectal examination (DRE) findings, and TRUS findings, between patients with and without prostate cancer. However, in the non-biopsy group, a hypoechoic lesion was found more frequently in patients with prostate cancer (prostate cancer vs. benign prostatic hyperplasia: 20.0 vs. 3.3 %, p = 0.02).
  
  
  CONCLUSIONS
  Prior negative prostate biopsy does not rule out the possibility of prostate cancer after HoLEP. The presence of a hypoechoic lesion on TRUS might be helpful to predict incidental prostate cancer after HoLEP in patients with normal PSA and negative DRE. Prostate biopsy prior to HoLEP should be considered in these patients.
authors: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors: Myong
authors: M
authors: Kim
authors: Sang Hoon
authors: SH
authors: Song
authors: Ja Hyeon
authors: JH
authors: Ku
authors: Seung-June
authors: SJ
authors: Oh
authors: Jae-Seung
authors: JS
authors: Paick
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D011184:Postoperative Period; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D012007:Rectum; D012189:Retrospective Studies