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Updated: Jun 25, 2026
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Reliability of Prostate Imaging-reporting and Data System Scoring Following Holmium Laser Enucleation of Prostate
Benjamin N Schmeusser1, Jason L Zappia1, Kyle R Edwards1
1Indiana University Department of Urology, Indianapolis, IN.
Objective:
To determine whether prostate magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring following holmium laser enucleation of the prostate (HoLEP) can reliably predict the detection of prostate cancer on prostate biopsy.
Methods:
Patients who underwent HoLEP followed by prostate MRI, targeted prostate biopsy, and systematic biopsy at a single institution from 2012 to 2024 were retrospectively reviewed. Patients were grouped based on highest PI-RADS score noted on prostate MRI. Patient demographics and clinical characteristics were gathered, and multivariate analyses were performed. Prevalence of prostate cancer detection based on PI-RADS score was calculated. Locations of PI-RADS lesions were also documented.
Results:
Forty-four patients who underwent HoLEP followed by prostate MRI and targeted biopsy were included in our analysis. In post-HoLEP patients with PI-RADS lesions of 3, 4 or 5, clinically significant prostate cancer was detected in 66.7%, 59%, and 100% of patients on biopsy, respectively. 83% (n=5) of patients with PI-RADS 1-2 lesions were found to have clinically significant prostate cancer on systematic biopsy.
Conclusion:
Prostate MRI and the PI-RADS system to detect prostate cancer appear to have utility in patients that underwent HoLEP. A high proportion of patients with low PI-RADS scores were found to have clinically significant prostate cancer on systematic biopsy, however, therefore, PI-RADS scoring alone should not impact a clinician's decision of whether to perform prostate biopsy. Additional characteristics such as PSA, PSA density, or PSA kinetics should also be considered when determining when to perform prostate biopsy in post-HoLEP patients.
Insights
Prostate MRI PI-RADS scoring after HoLEP shows some utility but shouldn't solely guide biopsy decisions. Clinically significant prostate cancer is often found even with low PI-RADS scores, necessitating consideration of other factors like PSA levels.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Holmium laser enucleation of the prostate (HoLEP) is a common treatment for benign prostatic hyperplasia.
- Post-HoLEP, accurate cancer detection is crucial, but imaging interpretation can be challenging.
- Prostate Magnetic Resonance Imaging (MRI) with the Prostate Imaging Reporting and Data System (PI-RADS) is increasingly used for prostate cancer assessment.
Purpose of the Study:
- To evaluate the predictive accuracy of PI-RADS scoring on prostate MRI for detecting prostate cancer after HoLEP.
- To determine if PI-RADS scores can reliably guide the need for prostate biopsy in post-HoLEP patients.
Main Methods:
- Retrospective review of 44 patients who underwent HoLEP, prostate MRI, and subsequent biopsies (targeted and systematic).
- Patients were categorized by their highest PI-RADS score on MRI.
- Prevalence of clinically significant prostate cancer detection was analyzed based on PI-RADS scores.
Main Results:
- Clinically significant prostate cancer was detected in 66.7% of patients with PI-RADS 3, 59% with PI-RADS 4, and 100% with PI-RADS 5.
- Notably, 83% of patients with PI-RADS 1-2 lesions were diagnosed with clinically significant cancer on systematic biopsy.
- PI-RADS lesions were documented by location.
Conclusions:
- Prostate MRI and PI-RADS scoring demonstrate utility in assessing post-HoLEP patients for prostate cancer.
- However, PI-RADS scores alone are insufficient for biopsy decisions due to high cancer detection rates in low PI-RADS categories.
- Consideration of PSA, PSA density, and PSA kinetics is recommended alongside PI-RADS for biopsy guidance in post-HoLEP patients.
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