Incidental Prostate Cancer in Patients Undergoing Surgery for Benign Prostatic Hyperplasia: A Predictive Model.

Background and objective: Histopathological examination of surgical specimens for benign prostatic hyperplasia (BPH) can detect incidental prostate cancer (iPCa). The aim of our study was to develop a predictive model for iPCa diagnosis for patients for whom BPH surgery is being considered.

Methods: We conducted a retrospective analysis of medical files for patients who underwent BPH surgery in three academic centers between 2012 and 2022. Patients diagnosed with PCa before surgery were excluded. We calculated the global iPCa rate, and the clinically significant iPCa rate (grade group ≥2). Univariate and multivariable regression models were used to assess factors predictive of iPCa. The area under the receiver operating characteristic curve (AUC) was compared for each risk factor and for the global model. We used χ² automated interaction detection (CHAID) for decision tree analysis.

Key findings and limitations: We included 2452 patients in the analysis, of whom 247 (10.0%) had iPCa, which was clinically significant in 49/247 cases (20.2%). Multivariable analysis revealed that age and prostate-specific antigen density (PSAD) were independent predictive factors for iPCa diagnosis. The AUC for a model including age and PSAD was 0.65. CHAID analysis revealed that patients with PSAD >0.1 ng/ml/cm³ had an iPCa risk of 23.4% (χ² = 52.6; p < 0.001). For those patients, age >72 yr increased the iPCa risk to 35.4% (χ² = 11.1, p = 0.008). Our study is mainly limited by its retrospective design.

Conclusions and clinical implications: Age and PSAD were independent risk factors for iPCa diagnosis. The combination of age >72 yr and PSAD >0.1 ng/ml/cm³ was associated with an iPCa rate of 35.4%.

Patient summary: We performed a study to find predictors of prostate cancer for patients undergoing surgery for benign enlargement of the prostate. Our model can identify patients at risk, and diagnose their cancer before surgery. This could avoid unnecessary or harmful procedures.