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Updated: Jan 16, 2026
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Incidental Prostate Cancer Detected in Holmium Laser Enucleation of the Prostate (HoLEP) Specimens: A Single-Center
Momen Sid Ahmed1, Nkwam Nkwam1
1Department of Urology, King's College Hospital NHS Foundation Trust, London, GBR.
Background:
Incidental prostate cancer (iPCa) is an unsuspected malignancy found in tissue resected for benign prostatic hyperplasia (BPH). We evaluated the prevalence and characteristics of iPCa among patients undergoing holmium laser enucleation of the prostate (HoLEP) at our center.
Methods:
We retrospectively reviewed 259 consecutive HoLEP cases. Patients with known prostate cancer before surgery were excluded from iPCa rate calculations. Demographics, prostate-specific antigen (PSA), prostate volume, and histopathology were recorded. Between-group comparisons were performed using the Mann-Whitney U test and the chi-square test (p < 0.05).
Results:
iPCa was identified in 37/259 (14.3%) cases. Gleason distribution among iPCa was 3+3=6 in 23/37 (62.2%), Gleason 7 in 9/37 (24.3%) (3+4=7 in eight; 4+3=7 in one), Gleason 8-10 in 4/37 (10.8%), and not assigned in 1/37 (2.7%). Patients with iPCa were slightly older (median age, 75 years) than those with benign histology (median age, 72 years; p=0.014). Median PSA (7.85 vs. 7.20 ng/mL; p=0.45), prostate volume (112.5 vs. 120 cc; p=0.25), PSA density (0.069 vs. 0.061 ng/mL/cc; p=0.29), and proportions with PSA>10 ng/mL (11/37 (29.7%) vs. 65/222 (29.3%); p=0.998) or prostate volume >100 cc (23/37 (62.2%) vs. 147/222 (66.2%); p=0.891) did not differ significantly.
Conclusion:
Approximately one in seven HoLEP patients (37/259, 14.3%) had iPCa, predominantly of the low-grade (23/37, 62.2%) type. Most cases were suitable for conservative management; only 4/259 (1.5%) of the entire cohort had incidentally detected high-grade (Gleason ≥8) disease.
