Incidental prostate cancer (iPCa) can be detected histopathologically following surgery for benign prostatic hyperplasia (BPH). This study analyzed the incidence, trends, and management of iPCa using the PearlDiver™ Mariner database, which includes over 41 billion de-identified patient records from 2011 to 2022. The analysis focused on BPH procedures leading to histological examination, including transurethral resection of the prostate (TURP), HoLEP/ThuLEP, and simple prostatectomy. Preoperative diagnostics, including biopsies and magnetic resonance imaging (MRI), were also examined. Advanced imaging techniques, such as ultrasound-guided biopsies, played a crucial role in pre-surgical evaluations.
Out of 231,626 BPH procedures, iPCa was identified in 5,090 patients (2.20%) with a mean age of 71.72 years. Preoperative biopsies were performed in 6.55% of patients, while MRI was used in 3.90%, showing a significant increase in MRI usage (p=0.002) alongside a decrease in biopsy rates (p<0.001). Interestingly, preoperative biopsy slightly increased the likelihood of diagnosing iPCa, while MRI appeared to reduce this risk, though neither reached statistical significance. No significant differences in iPCa risk were observed between the surgical approaches.
The overall incidence of iPCa remained low (<3%) and stable over the study period. Most cases (95.85%) did not receive active treatment, with only a small percentage undergoing radical prostatectomy (0.53%), radiotherapy (0.12%), or androgen deprivation therapy (3.50%). The findings suggest that preoperative imaging, particularly MRI and ultrasound-guided diagnostics, is increasingly preferred for evaluating BPH patients and may reduce unnecessary biopsies. Additionally, iPCa detected post-surgery is often of low clinical significance, requiring minimal intervention.
