Incidental prostate cancer: is prostate-specific antigen density a valid predictor? A case-control study

Area of Science:

• Urology
• Oncology

Background:

• Benign prostatic hyperplasia (BPH) is common in aging men, often requiring surgical intervention.
• Incidental prostate cancer (iPCa) can be discovered during surgery for BPH.
• Predictive markers for iPCa in this context are crucial for appropriate patient management.

Purpose of the Study:

• To determine if prostate-specific antigen density (PSAD) can predict the presence of incidental prostate cancer (iPCa).
• To evaluate PSAD's utility in patients undergoing robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH).

Main Methods:

• 100 patients undergoing RASP for BPH were analyzed.
• Patients were stratified by PSAD levels (≤0.1 ng/mL/cc and >0.1 ng/mL/cc).
• Multivariable logistic regression and univariate linear regression were used to assess PSAD's predictive value for iPCa.

Main Results:

• Incidental prostate cancer (iPCa) was detected in 8% of cases.
• A prior negative prostate biopsy was the strongest predictor of iPCa (OR=5.2, p=0.01).
• PSAD, dichotomized or continuous, did not significantly predict iPCa in this cohort (p>0.05).

Conclusions:

• PSAD is not a reliable predictor of iPCa in men with large prostates undergoing RASP for BPH.
• Prostate MRI before surgery may improve cancer detection in select patients.
• Further research with larger studies is needed to validate these findings.