Comorbidities as predictors of incidental prostate cancer after Holmium laser enucleation of the prostate: diabetes and high-risk cancer

Abstract

Prostate cancer can be diagnosed as an incidental finding during the pathological examination of benign prostatic hyperplasia (BPH) specimens by Holmium laser enucleation of the prostate (HoLEP). BPH and comorbidities such as hypertension, diabetes, and dyslipidemia often coexist in elderly people. We identified which comorbidities can be used to predict the presence of incidental prostate cancer, particularly high-risk cancer, in men who had undergone HoLEP. On the basis of pathological findings of HoLEP specimens, patients with incidental cancer were categorized as low-risk (Gleason ≤6 and T1a) or high-risk (all others). Of the 654 patients who underwent HoLEP, 41 patients (6.3%) were identified as having incidental cancer (25 low-risk and 16 high-risk). There were no significant factors for overall prostate cancers. However, a significantly higher frequency of diabetes was observed in patients with high-risk cancer compared to those with BPH (31% vs. 13%; p = .033). Logistic regression analysis using prostate-specific antigen (PSA) and prostate volume (PV), and smoking showed that diabetes was an independent predictor of high-risk cancer (odds ratio, 3.15; 95% confidence interval, 1.06–9.43). Diabetes may be an important predictor of the presence of high-risk prostate cancer in men with BPH who have undergone HoLEP.

Keywords:

• Benign prostatic hyperplasia
• comorbidities
• diabetes
• Holmium laser
• prostate cancer

Disclosure statement

The authors report no conflicts of interest.

Notes on contributors

Kazuhiro Ohwaki is the Director of the Health Management Center at JCHO Tokyo Shinjuku Medical Center. He is also an Adjunct Research Staff of the Department of Urology at St. Luke’s International Hospital. His research interests include clinical epidemiology and preventive medicine.

Fumiyasu Endo is a Head Physician of the Department of Urology at St. Luke’s International Hospital. His clinical interests include benign prostatic hyperplasia, HoLEP, and robotic surgery.

Masaki Shimbo is an Assistant Head Physician of the Department of Urology at St. Luke’s International Hospital. His clinical interests include general urology, HoLEP, and robotic surgery.

Akiko Fujisaki is an Adjunct Medical Staff of the Department of Urology at St. Luke’s International Hospital. Her clinical interest is in general urology.

Kazunori Hattori is the Director of the Department of Urology at St. Luke’s International Hospital. His clinical interests include robotic surgery, laparoscopic surgery, adrenal gland tumor, and malignant tumor of urinary tract.