title: Coexisting prostate cancer found at the time of holmium laser enucleation of the prostate for benign prostatic hyperplasia: predicting its presence and grade in analyzed tissue.
abstract: OBJECTIVE
  To determine the incidence of prostate cancer identified on holmium laser enucleation of the prostate (HoLEP) specimens and evaluate variables associated with prostate cancer identification.
  
  
  METHODS
  All patients undergoing HoLEP between 1998 and 2013 were identified. Patients with a known history of prostate cancer were excluded. Multivariable logistic regression assessed variables associated with identification of prostate cancer on HoLEP specimens and Gleason 7 or higher prostate cancer among the malignant cases. The Gleason grade was used as a proxy for disease severity. Each of the models was adjusted for age, preoperative prostate-specific antigen (PSA), and HoLEP specimen weight.
  
  
  RESULTS
  The cohort comprised 1272 patients, of whom 103 (8.1%) had prostate cancer identified. Prostate cancer cases had higher pre-HoLEP PSA (p=0.06) but lower HoLEP specimen weight (p=0.01). On multivariate logistic regression, age and preoperative PSA were associated with increased odds of prostate cancer being present (p<0.01 each), while increasing HoLEP specimen weight was associated with decreased odds of prostate cancer (p<0.001). Men older than 80 had 20% predicted probability of being diagnosed with prostate cancer. Seventy-eight percent of prostate cancer cases were Gleason 6 or less. The pre-HoLEP PSA was associated with increased adjusted odds of intermediate- or high-grade prostate cancer.
  
  
  CONCLUSIONS
  Prostate cancer identified by HoLEP is not uncommon, but is generally a low-risk disease. Older patients with smaller prostate glands have the highest odds of prostate cancer identification.
authors.affiliation: 1 Department of Urology, Centre Hospitalier de l'Université de Montréal , Montréal, Québec, Canada .
authors.forename: Naeem
authors.initials: N
authors.lastname: Bhojani
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Boris
authors.forename: M Francesca
authors.initials: MF
authors.lastname: Monn
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Mandeville
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D033162:Incidental Findings; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000473:pathology*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate
chemical_list: D017430:Prostate-Specific Antigen