Predictive Modeling of Incidental Prostate Cancer Risk in Benign Prostatic Hyperplasia Surgery

Sep 26, 2024

Photo Credit: ALIOUI Mohammed Elamine

The following is a summary of “Incidental Prostate Cancer in Patients Undergoing Surgery for Benign Prostatic Hyperplasia: A Predictive Model,” published in the September 2024 issue of Urology by Anract et al.

Histopathological evaluation of surgical specimens from patients undergoing surgery for benign prostatic hyperplasia (BPH) often reveals incidental prostate cancer (iPCa). This study aims to develop a predictive model for diagnosing iPCa in patients being considered for BPH surgery. Researchers performed a retrospective analysis of medical records from three academic centers, encompassing patients who underwent BPH surgery between 2012 and 2022, excluding those with preoperative prostate cancer diagnoses. Their analysis focused on calculating the overall rate of iPCa and the rate of clinically significant iPCa (grade group ≥2). Univariate and multivariable regression analyses were employed to identify predictors of iPCa, with the area under the receiver operating characteristic curve (AUC) used to evaluate the performance of each risk factor and the global model.

Additionally, χ² automated interaction detection (CHAID) was utilized for decision tree analysis. Out of 2,452 patients included in the study, 247 (10.0%) were found to have iPCa, with 49 of these cases (20.2%) being clinically significant. Multivariable analysis identified age and prostate-specific antigen density (PSAD) as independent predictors of iPCa. The AUC for a model incorporating both age and PSAD was 0.65. CHAID analysis indicated that patients with a PSAD greater than 0.1 ng/ml/cm³ had a 23.4% risk of iPCa (χ² = 52.6; p < 0.001). For patients with PSAD >0.1 ng/ml/cm³, those older than 72 years had an increased iPCa risk of 35.4% (χ² = 11.1; p = 0.008). The study’s main limitation is its retrospective nature. In conclusion, both age and PSAD are significant independent risk factors for iPCa. Specifically, the combination of age over 72 years and a PSAD greater than 0.1 ng/ml/cm³ correlates with a notably high iPCa risk of 35.4%.