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).