PD56-01 PROSTATE SPECIFIC ANTIGEN KINETICS PREDICT INCIDENTAL PROSTATE CANCER PROGRESSION FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE

Abstract

Introduction & Objective: Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is an effective outlet procedure and has a higher incidental prostate cancer (PrCA) rate than traditional BPH procedures. Outcome data regarding the clinical progression of patients with prostate cancer following HoLEP is lacking. We aim to describe the clinical course as well as disease progression of PrCA following HoLEP. Method(s): A retrospective review of HoLEP surgeries at our institution by a single surgeon was performed. We included patients with prostate cancer diagnosed preoperatively or incidentally at the time of HoLEP. Clinical progression was defined as the need for additional therapies following HoLEP. We excluded patients undergoing HoLEP prior to planned definitive therapy for prostate cancer in the sub-analysis for clinical progression. Result(s): 1,288 HoLEP cases were performed by a single surgeon, 152 of whom had PrCA. 133 (10.4%) were incidentally diagnosed. Following HoLEP, 23/149 (15.4%) patients met criteria for clinical progression at a median of 20 months. The clinical progression group demonstrated a significantly higher preoperative prostate specific antigen (PSA), preoperative PSA density (PSAD), first postoperative PSA, postoperative PSAD, and PSA velocity. After HoLEP, twelve (7.8%) patients underwent radiation therapy, 18 (11.8%), underwent androgen deprivation, 6 (4%) underwent robot assisted radical prostatectomy, and 1 (0.6%) underwent high intensity focused ultrasound of the prostate. Patients were more likely to demonstrate clinical progression with PSA velocity >0.75 ng/dL/year (OR 19.3, 95% CI 4.9-75.8, p < 0.01) and a PSA doubling time (PSADT) <36 months (OR 10.2, 95% CI 1.3-81.6, p < 0.01). When predicting clinical progression following HoLEP, the sensitivity of PSADT <36 months was 94%, the negative predictive values for a PSA velocity <0.75 ng/dL/year was 95%, and PSADT >36 months was 97%. The estimated overall survival for all patients at 5 and 10 years was 87.4% and 58.7%, respectively. There was no significant difference in estimated overall survival in those that did vs. did not clinically progress (89.2 vs. 97.3 months, p = 0.72). Conclusion(s): Following HoLEP, patients with PrCA should be surveyed closely for clinical progression. We identified PSA kinetics to be critical in assessing the risk of clinical progression following HoLEP. While PSA surveillance is an important determinant in the decision making regarding additional therapies, there is also a need to identify factors that guide patients to watchful waiting, without exposing them to additional testing and biopsies involved in active surveillance.