Results
The mean age of all patients included in the study was 69.47±7.97
(range, 47-90) years. The median PSA level was 7.49 (range,
0.18-121.15). The demographic data of the patients are given in Table 1.
Among the 430 patients that underwent OP with a pre-diagnosis of BPH,
406 (94.4%) with a benign diagnosis after OP were included in the BPH
group and 24 (5.6%) detected to have PCa after OP constituted the
incidental PCa group. In the incidental PCa group, 21 (87.5%) patients
had GS 3+3, one patient had GS 3+4 (4.1%), one had GS 4+4 (4.1%), and
one had GS 4+5 (4.1%) prostatic adenocarcinoma. The histopathological
evaluation revealed 29 cases of low grade prostatic intraepithelial
neoplasia (PIN), three high grade PIN, 19 squamous metaplasia, five
prostatitis and three atypical small acinar proliferation accompanying
BPH after OP. A preoperative prostate biopsy was performed in 128
(31.5%) patients in the BPH group and 19 (79.1%) in the incidental PCa
group.
In the univariate analysis, age, AST/ALT ratio, MetS, and DRE
significantly differed between the groups (p=0.008, p=0.005, p=0.004,
and p<0.001, respectively). The rate of incidental PCa was
much higher in the elderly patients. In the ROC analysis, the cut-off
value of age was 71.5 years in the incidental PCa group [area under
the curve (AUC): 0.672, confidence interval (CI) 95%:0.574-0.770,
sensitivity: 75%, specificity: 36.9%, p=0.005). Preoperative drug use
for lower urinary tract symptoms, serum PSA, PSA density, prostate
volume, free/total PSA ratio, NLR, and PLR were not significantly
different in the BPH and incidental PCa groups (p>0.05)
(Table 2).
The multivariate analysis revealed that only DRE and presence of MetS
were effective in predicting PCa among all the parameters that were
significant in the univariate analysis. DRE was 16 times more effective
[df (1)=29.585, odds ratio (OR): 16.215, 95% CI: 5.942-44.249,
p<0.001) and MetS was 2.8 times more effective [df
(1)=4.656, OR: 2.808, 95%CI: 1.099-7.172, p=0.031] than the remaining
parameters (Table 2).
The median follow-up duration for the incidental PCa group was 41.5
(14-86) months. In two (8.3%) patients that were defined to be
high-risk, hormonotherapy was initiated immediately after OP. In a
further two patients (8.3%), increasing PSA levels were detected, and
therefore hormonotherapy was started. No metastasis was detected in any
of the patients even in the high-risk group (GS 8 and 9).