Is the systematic histological analysis of benign prostatic hyperplasia surgical specimen always necessary?

After most surgical management of benign prostatic hyperplasia (BPH), the resected tissue undergoes a histological examination. This examination is performed for the risk of finding an incidental prostate cancer (iPCa). The improvement of prostate cancer detection in the past few years decreased the global iPCa rate. This raises the question of the real benefit for all patients of a systematic histological analysis. The aim of our study was to evaluate the iPCa detection rate on a large contemporary cohort of patients treated for BPH, and to define predictive factors of iPCa detection.

We retrospectively analyzed the medical charts of all consecutive patients who underwent surgical treatment for BPH in our academic center from 2012 to 2018. Patients with prostate cancer diagnosed before surgery were not included. All the resected tissue underwent standard histopathological examination. iPCa was defined by any grade or stage of prostate cancer identified on the resected tissue by the histological examination. The following variables were analyzed using an uni- and multi-variable logistic regression as potential risk factors of iPCa: age, total PSA, PSA density (PSAd), prostate volume, technique used, weight of resected tissue and use of 5ARI medication.

1045 patients were included in the study. Of them, 439 (42.0%), 206 (19.7%) and 400 (38.3%) underwent HoLEP, OP and TURP, respectively. iPCa was diagnosed in 94 (9.0%) of the 1045. Among them 15 (1.4%) were clinically significant (ISUP score ≥ 2). The multivariable logistic regression analysis identified age (p = 0.03) and PSA density (p < 0.001) as independent predictive factors for the detection of iPCa. Using the median of age and PSAd, we identified a population with 0% of iPCa in our cohort (age < 70 year-old and PSAd < 0.05 ng/mL/mL).

The global iPCa rate was 9% in this contemporary large cohort of patients who underwent surgical treatment for BPH, with 1.4% of clinically significant cancer. Age and PSAd were independent predictive factors to find iPCa. Patients younger than 70 with a PSAd < 0.05 ng/mL/mL had 0% of iPCA in our cohort. In this specific population, we could probably avoid a systematical histological examination of the resected tissue.