Risk factors for incidental prostate cancer following surgery for benign prostatic enlargement: A systematic review and meta-analysis.
Angelo Cormio, Akihiro Matsukawa, Alessandro Dematteis et al.
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In 30 seconds
This systematic review and random-effects meta-analysis examined clinical predictors of incidental prostate cancer (IPC) in patients undergoing surgery for benign prostatic enlargement. It included 25 studies and 247,966 patients; 6,748 had IPC, with reported rates ranging from 2.2% to 49.6%. Higher PSA, PSA density >0.15 ng/mL/cc, older age, and higher BMI were associated with increased IPC risk. Preoperative 5-alpha reductase inhibitor use was associated with lower risk (OR: 0.53; 95% CI: 0.33-0.85; p = 0.01).
Key findings
- PSA density >0.15 ng/mL/cc was associated with higher IPC risk (OR: 3.02; 95% CI: 1.50-6.07; p = 0.01).
- Elevated PSA, older age, and higher BMI were also associated with increased IPC risk.
- Preoperative 5-alpha reductase inhibitor use was associated with reduced IPC risk (OR: 0.53; 95% CI: 0.33-0.85; p = 0.01).
- Prostate volume, diabetes, and dyslipidemia were not associated with IPC risk.
Why it matters
IPC is detected in a subset of patients undergoing surgery for benign prostatic enlargement, and the pooled findings identify clinical characteristics associated with its occurrence. These associations may help frame preoperative risk assessment, while the wide range of reported IPC rates and uncertainty about clinically significant disease underscore the need for cautious interpretation.
What to keep in mind
The review reports heterogeneity across studies, retrospective designs, and incomplete reporting of key variables.