Incidencia y factores de riesgo asociados al cáncer de próstata incidental en pacientes sometidos a enucleación prostática con láser de holmio (HoLEP)
DOI:
https://doi.org/10.48193/qqtn6r86Palabras clave:
CPI, HoLEP, PSA, Factores de riesgoResumen
Objetivo: evaluar la incidencia y los factores de riesgo asociados al diagnóstico de cáncer de próstata incidental (CPI) en pacientes sometidos a enucleación prostática con láser de holmio (HoLEP).
Material y métodos: estudio retrospectivo en 145 pacientes sometidos a HoLEP entre 2022 y 2024. Se analizaron variables clínicas y bioquímicas. Se aplicaron pruebas de chi-cuadrada, correlación de Pearson y análisis de curvas ROC. Se consideró significancia estadística con p < 0.05.
Resultados: se identificó CPI en nueve pacientes (6.2 %). El antígeno prostático específico total (t-PSA) y la densidad de antígeno prostático específico total (t-PSA-D) fueron significativamente mayores en el grupo con CPI. tPSA-D presentó el mejor desempeño predictivo (AUC = 0.913; IC95 %: 0.835–0.991; p < 0.001), seguida del t-PSA (AUC = 0.844; p < 0.001) y la edad (AUC = 0.703; p = 0.014). Se observó una correlación negativa fuerte entre el volumen enucleado y el tPSA posquirúrgico (r = –0.77).
Limitaciones del estudio: el carácter retrospectivo del estudio, así como el tamaño de la muestra podrían restringir la generalización de los resultados.
Originalidad o valor: los hallazgos de este trabajo permiten optimizar la selección preoperatoria de pacientes sometidos a HoLEP.
Conclusiones: la incidencia de CPI fue del 6.2 %. El t-PSA, t-PSA-D y la edad se asociaron significativamente con el diagnóstico de CPI.
Referencias
Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, et al. Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer; 2024.
Fleshner K, Carlsson SV, Roobol MJ. The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nature Reviews. Urology. 2017;14(1): 26–37. https://doi.org/10.1038/nrurol.2016.251.
Guzman-Esquivel J, Murillo-Zamora E, Ortiz-Mesina M, Galvan-Salazar HR, De-Leon-Zaragoza L, Casarez-Price JC, et al. Regional and national burden of prostate cancer: incidence, mortality, years of life lost, and disability-adjusted life years, in Mexico and Latin America from 1990 to 2019. International Urology and Nephrology. 2023;55(9): 2155–2160. https://doi.org/10.1007/s11255-023-03653-7.
Lee MS, Assmus MA, Guo J, Siddiqui MR, Ross AE, Krambeck AE. Relationships between holmium laser enucleation of the prostate and prostate cancer. Nature Reviews. Urology. 2023;20(4): 226–240. https://doi.org/10.1038/s41585-022-00678-y.
Helo SWC, Welliver RC, McVary KT. Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia. In: Campbell-Walsh-Wein Urology. 12th edn Elsevier; 2021.
Roehrborn CG. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History. In: Campbell Walsh Wein Urology. 12th edn Elsevier; 2021.
Guo Z, He J, Huang L, Wang Z, Hu P, Wang S, et al. Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis. International Braz J Urol: Official Journal of the Brazilian Society of Urology. 2022;48(6): 915–929. https://doi.org/10.1590/S1677-5538.IBJU.2021.0653.
Tanaka T, Koie T, Ohyama C, Hashimoto Y, Imai A, Tobisawa Y, et al. Incidental prostate cancer in patients with muscle-invasive bladder cancer who underwent radical cystoprostatectomy. Japanese Journal of Clinical Oncology. 2017;47(11): 1078–1082. https://doi.org/10.1093/jjco/hyx119.
Capitanio U, Scattoni V, Freschi M, Briganti A, Salonia A, Gallina A, et al. Radical prostatectomy for incidental (stage T1a-T1b) prostate cancer: analysis of predictors for residual disease and biochemical recurrence. European Urology. 2008;54(1): 118–125. https://doi.org/10.1016/j.eururo.2008.02.018.
Joung JY, Yang SO, Seo HK, Kim TS, Han KS, Chung J, et al. Incidental prostate cancer detected by cystoprostatectomy in Korean men. Urology. 2009;73(1): 153–157. https://doi.org/10.1016/j.urology.2008.02.040.
Zigeuner RE, Lipsky K, Riedler I, Auprich M, Schips L, Salfellner M, et al. Did the rate of incidental prostate cancer change in the era of PSA testing? A retrospective study of 1127 patients. Urology. 2003;62(3): 451–455. https://doi.org/10.1016/s0090-4295(03)00459-x.
Yoo C, Oh CY, Kim SJ, Kim SI, Kim YS, Park JY, et al. Preoperative clinical factors for diagnosis of incidental prostate cancer in the era of tissue-ablative surgery for benign prostatic hyperplasia: a korean multi-center review. Korean Journal of Urology. 2012;53(6): 391–395. https://doi.org/10.4111/kju.2012.53.6.391.
Han JH, Chung DH, Cho MC, Ku JH, Jeong CW, Kwak C, et al. Natural history of incidentally diagnosed prostate cancer after holmium laser enucleation of the prostate. PLOS ONE. 2023;18(2): e0278931. https://doi.org/10.1371/journal.pone.0278931.
Sakai A, Borza T, Antar A, Richmond E, Allen GO, Knoedler M, et al. Incidental Prostate Cancer Diagnosis Is Common After Holmium Laser Enucleation of the Prostate. Urology. 2024;183: 170–175. https://doi.org/10.1016/j.urology.2023.11.014.
Kim M, Song SH, Ku JH, Oh SJ, Paick JS. Prostate cancer detected after Holmium laser enucleation of prostate (HoLEP): significance of transrectal ultrasonography. International Urology and Nephrology. 2014;46(11): 2079–2085. https://doi.org/10.1007/s11255-014-0777-z.
Rivera ME, Lingeman JE, Krambeck AE. Holmium Laser Enucleation of the Prostate. Journal of Endourology. 2018;32(S1): S7–S9. https://doi.org/10.1089/end.2017.0710.
Mauler DJ, Sella DM, Dora CD. Utilizing Preoperative Magnetic Resonance Imaging to Self-assess Enucleation Ratio in Holmium Laser Enucleation of the Prostate. Urology. 2022;160: 176–181. https://doi.org/10.1016/j.urology.2021.11.009.
Watanabe H, Igari D, Tanahashi Y, Harada K, Saito M. Measurements of size and weight of prostate by means of transrectal ultrasonotomography. The Tohoku Journal of Experimental Medicine. 1974;114(3): 277–285. https://doi.org/10.1620/tjem.114.277.
Martos M, Katz JE, Parmar M, Jain A, Soodana-Prakash N, Punnen S, et al. Impact of perioperative factors on nadir serum prostate-specific antigen levels after holmium laser enucleation of prostate. BJUI compass. 2021;2(3): 202–210. https://doi.org/10.1002/bco2.68.
Saitta G, Becerra JEA, Del Álamo JF, González LL, Elbers JR, Suardi N, et al. ‘En Bloc’ HoLEP with early apical release in men with benign prostatic hyperplasia. World Journal of Urology. 2019;37(11): 2451–2458. https://doi.org/10.1007/s00345-019-02671-4.
Elmansy HM, Kotb A, Elhilali MM. Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup. The Journal of Urology. 2011;186(5): 1972–1976. https://doi.org/10.1016/j.juro.2011.06.065.
Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. European Urology. 2008;53(1): 160–166. https://doi.org/10.1016/j.eururo.2007.08.036.
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