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Do Prostate Imaging-Reporting and Data System (PIRADS) lesions predict holmium laser enucleation of prostate
Kyle Tsai1, Perry Xu1, Jenny Guo1
1Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Introduction And Objectives:
Prostate magnetic resonance imaging (MRI) is used for prostate cancer (PCa) screening and risk stratification and is helpful for surgical planning for patients undergoing holmium laser enucleation of the prostate (HoLEP). There are few studies investigating the correlation between MRI Prostate Imaging-Reporting and Data System (PIRADS) lesion characteristics and HoLEP pathology and outcomes.
Methods:
We performed retrospective review of patients who underwent HoLEP between January 2021 and August 2023 by a single surgeon. Preoperative, intraoperative, and postoperative characteristics and outcomes were analyzed for all patients who had a documented preoperative prostate MRI.
Results:
There were 334 patients without a pre-existing diagnosis of PCa and with a preoperative prostate MRI, of which 140 (42%) had at least one PIRADS lesion. There was a total of 203 PIRADS lesions: 91 (45%) in the peripheral zone (PZ), 106 (52%) in the transition zone (TZ), and 6 (2%) not specified. Incidental PCa was noted in 44 (13%) patients at time of HoLEP. Presence or location of lesion was not significantly associated with rate or grade of incidental PCa on pathology. Greater number of lesions and lesion size correlated with longer procedure times. Lesion number, size, or grade were not found to correlate with cancer grade or rate of cancer.
Conclusions:
Grade, presence, location, size, and number of PIRADS lesions on preoperative prostate MRI for patients with an appropriate prior PCa workup were not significantly associated with incidental PCa or higher PCa grade on HoLEP pathology.
Insights
Prostate MRI PIRADS lesion characteristics do not predict incidental prostate cancer (PCa) found during holmium laser enucleation of the prostate (HoLEP). Lesion number and size correlated with longer procedure times but not cancer outcomes.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Prostate MRI, utilizing the Prostate Imaging-Reporting and Data System (PIRADS), is crucial for prostate cancer (PCa) detection and surgical planning.
- Holmium laser enucleation of the prostate (HoLEP) is a common procedure for benign prostatic hyperplasia, but incidental PCa can be discovered during surgery.
Purpose of the Study:
- To investigate the association between preoperative prostate MRI PIRADS lesion characteristics and the pathology and outcomes of incidental PCa detected during HoLEP.
- To determine if MRI findings correlate with the rate or grade of prostate cancer found incidentally during HoLEP.
Main Methods:
- Retrospective review of 334 patients who underwent HoLEP with preoperative prostate MRI.
- Analysis of patient demographics, MRI PIRADS lesion characteristics (grade, number, size, location), and HoLEP pathology outcomes.
- Correlation of lesion characteristics with the presence, rate, and grade of incidental PCa.
Main Results:
- 140 patients (42%) had at least one PIRADS lesion; 203 lesions were identified.
- Incidental PCa was found in 13% of patients.
- No significant association was found between PIRADS lesion presence, location, or grade and the rate or grade of incidental PCa.
- A greater number and larger size of PIRADS lesions correlated with longer HoLEP procedure times.
Conclusions:
- Preoperative prostate MRI PIRADS lesion characteristics are not significantly associated with the detection or grade of incidental prostate cancer found during HoLEP.
- While lesion characteristics do not predict cancer, they may influence surgical procedure duration.
