Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

Zhenlang Guo; Junwei He; Lijuan Huang; Zhaohui Wang; Ping Hu; Shusheng Wang; Zunguang Bai; Jun Pan

doi:10.1590/S1677-5538.IBJU.2021.0653

Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

Int Braz J Urol. 2022 Nov-Dec;48(6):915-929. doi: 10.1590/S1677-5538.IBJU.2021.0653.

Authors

Zhenlang Guo¹, Junwei He¹, Lijuan Huang², Zhaohui Wang¹, Ping Hu¹, Shusheng Wang¹, Zunguang Bai¹, Jun Pan¹

Affiliations

¹ Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
² Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Abstract

Background: This study aimed to explore the prevalence and clinical risk factors in patients diagnosed with incidental prostate cancer (IPC) during certain surgeries (transurethral resection of the prostate [TURP], open prostatectomy [OP], and holmium laser enucleation of the prostate [HoLEP]) after clinically suspected benign prostatic hyperplasia (BPH).

Materials and methods: Literature search of the MEDILINE, Web of Science, Embase, and Cochrane Library databases was performed to identify eligible studies published before June 2021. Multivariate adjusted odds ratios (ORs) and associated 95% confidence intervals (CIs) of the prevalence and clinical risk factors of IPC were calculated using random or fixed-effect models.

Results: Twenty-three studies were included in the meta-analysis. Amongst the 94.783 patients, IPC was detected in 24.715 (26.1%). Results showed that the chance of IPC detection (10%, 95% CI: 0.07-4.00; P<0.001; I2=97%) in patients treated with TURP is similar to that of patients treated with HoLEP (9%, 95% CI: 0.07-0.11; P<0.001; I2=81.4%). However, the pooled prevalence estimate of patients treated with OP was 11% (95% CI: -0.03-0.25; P=0.113; I2=99.1%) with no statistical significance. We observed increased incidence of IPC diagnosis after BPH surgery amongst patients with higher prostate-specific antigen (PSA) level (OR: 1.13, 95% CI: 1.04-1.23; P=0.004; I2=89%), whereas no effect of age (OR: 1.02, 95% CI: 0.97-1.06; P=0.48; I2=78.8%) and prostate volume (OR: 0.99, 95% CI: 0.96-1.03; P=0.686; I2=80.5%) were observed.

Conclusions: The prevalence of IPC was similar amongst patients undergoing TURP, HoLEP, and OP for presumed BPH. Interestingly, increased PSA level was the only independent predictor of increasing risk of IPC after BPH surgery rather than age and prostate volume. Hence, future research should focus on predictors which accurately foretell the progression of prostate cancer to determine the optimal treatment for managing patients with IPC after BPH surgery.

Keywords: Meta-Analysis as Topic; Prevalence; Risk Factors; Prostatic Hyperplasia.

Copyright® by the International Brazilian Journal of Urology.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Humans
Laser Therapy* / adverse effects
Laser Therapy* / methods
Lasers, Solid-State* / therapeutic use
Male
Prevalence
Prostate-Specific Antigen
Prostatic Hyperplasia* / surgery
Prostatic Neoplasms* / diagnosis
Prostatic Neoplasms* / surgery
Risk Factors
Transurethral Resection of Prostate* / adverse effects
Transurethral Resection of Prostate* / methods
Treatment Outcome

Substances

Prostate-Specific Antigen

Grants and funding

This study was supported by grants from the Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine (No. YN2019ML05).