{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:59:15Z","timestamp":1775091555252,"version":"3.50.1"},"reference-count":15,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Background: Incidental prostate cancer (iPCa) remains a clinically relevant diagnosis in men undergoing surgery for benign prostatic hyperplasia (BPH). This study aimed to determine the incidence, characterize pathological features, and identify preoperative predictors of iPCa.Materials and methods: We conducted a retrospective cohort study of 735 men undergoing BPH surgery between November 2020 and December 2024. Demographic, clinical, surgical, and pathological variables were analyzed. Predictors of iPCa were evaluated using logistic regression; discrimination was assessed by ROC curves and Youden-optimized cut-offs.Results: The incidence of iPCa was 5.6%. Among iPCa cases, 48.8% were ISUP 1, while 17.1% corresponded to high-grade tumors (ISUP \u22654). Patients with iPCa had significantly higher PSA (4.8 vs 1.9 ng\/mL), higher PSA density (PSAD 0.099 vs 0.029 ng\/mL\/cm\u00d1), and smaller prostates (47 vs 66 mL) (all p&lt;0.001). In multivariable analysis including age and PSAD, only PSAD remained independently associated with iPCa (per 0.01 ng\/mL\/cm\u00d1 increase). PSAD discriminated iPCa better than PSA (AUC 0.86 vs 0.80). A PSAD threshold around 0.15 ng\/mL\/cm\u00d1 provided balanced performance (sensitivity \u22480.82; specificity \u22480.78). At a median follow-up of 24 months, most patients were managed conservatively (active surveillance or watchful waiting) with favorable short-term biochemical control; a minority required systemic therapy (hormonotherapy), and cancer-specific mortality was low.Conclusions: iPCa occurred infrequently after BPH surgery, although higher-grade tumors were still observed. PSA density was the strongest preoperative predictor and should be integrated into risk stratification before BPH surgery.<\/jats:p>","DOI":"10.4081\/aiua.2026.14669","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:01:13Z","timestamp":1771632073000},"source":"Crossref","is-referenced-by-count":0,"title":["Incidental prostate cancer following surgery for benign prostatic hyperplasia: a cohort study"],"prefix":"10.4081","volume":"98","author":[{"given":"Rui","family":"Pedrosa","sequence":"first","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9585-2609","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Lorigo","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Jo\u00e3o","family":"Guerra","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e1rbara","family":"Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9225-1437","authenticated-orcid":false,"given":"Vasco","family":"Quaresma","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9392-9211","authenticated-orcid":false,"given":"Miguel","family":"Eliseu","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo","family":"Temido","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnaldo","family":"Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Urology and Renal Transplantation, ULS Coimbra"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"214804","doi-asserted-by":"crossref","unstructured":"1. Guo Z, He J, Huang L, et al. Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: a systematic review and meta-analysis. Int Braz J Urol. 2022;48:915-929.","DOI":"10.1590\/s1677-5538.ibju.2021.0653"},{"key":"214805","doi-asserted-by":"crossref","unstructured":"2. Capogrosso P, Capitanio U, Vertosick EA, et al. Temporal trend in incidental prostate cancer detection at surgery for benign prostatic hyperplasia. Urology. 2018; 122:152-57.","DOI":"10.1016\/j.urology.2018.07.028"},{"key":"214806","doi-asserted-by":"crossref","unstructured":"3. Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2015;67:1099-1109.","DOI":"10.1016\/j.eururo.2014.12.038"},{"key":"214807","doi-asserted-by":"crossref","unstructured":"4. Wang Y, Li X, Yang H, et al. Predictive factors of incidental prostate cancer in patients undergoing surgery for presumed benign prostatic hyperplasia: an updated systematic review and meta-analysis. Front Oncol. 2025; 15:1561675.","DOI":"10.3389\/fonc.2025.1561675"},{"key":"214808","doi-asserted-by":"crossref","unstructured":"5. Yilmaz M, Toprak T, Suarez-Ibarrola R, et al. Incidental prostate cancer after holmium laser enucleation of the prostate\u2013A narrative review. Andrologia. 2022;54:e14332.","DOI":"10.1111\/and.14332"},{"key":"214809","doi-asserted-by":"crossref","unstructured":"6. Otto B, Barbieri C, Lee R, et al. Incidental prostate cancer in transurethral resection of the prostate specimens in the modern era. Adv Urol. 2014; 2014:627290.","DOI":"10.1155\/2014\/627290"},{"key":"214810","unstructured":"7. Shvero A, Teplitsky S, Kloniecke E, Das AK. Incidental prostate cancer at holmium laser enucleation of the prostate. Can J Urol. 2021; 28:10900-10906."},{"key":"214811","doi-asserted-by":"crossref","unstructured":"8. Porcaro AB, Tafuri A, Inverardi D, et al. Incidental prostate cancer after transurethral resection of the prostate: analysis of incidence and risk factors in 458 patients. Minerva Urol Nephrol. 2021; 73:471-480.","DOI":"10.23736\/S2724-6051.19.03564-1"},{"key":"214812","doi-asserted-by":"crossref","unstructured":"9. Abedi AR, Ghiasy S, Fallah-karkan M, et al. The management of patients diagnosed with incidental prostate cancer: narrative review. Res Rep Urol 2020;12:105-109.","DOI":"10.2147\/RRU.S245669"},{"key":"214813","doi-asserted-by":"crossref","unstructured":"10. Li X, Chen Y, Zhang Q, et al. Modern predictors and management of incidental prostate cancer (iPCa). Prostate. 2024; 84:1061-73.","DOI":"10.1002\/pros.24781"},{"key":"214814","unstructured":"11. Anract J, Roussel E, Lef\u00e8vre L, et al. Incidental prostate cancer in BPH surgery: contemporary predictors and clinical implications. Curr Probl Cancer 2025;49:100193."},{"key":"214815","doi-asserted-by":"crossref","unstructured":"12. Leni R, Dinh A, Durand X, et al. Management and oncologic outcomes of incidental prostate cancer detected after surgery for BPH. J Urol. 2024; 212:445-454.","DOI":"10.1097\/JU.0000000000004159"},{"key":"214816","unstructured":"13. Leni R, Lefebvre D, Hsu C, et al. Oncologic outcomes of incidental versus biopsy-detected prostate cancer: a comparative study. Prostate Cancer Prostatic Dis. 2024; 27:981-990."},{"key":"214817","unstructured":"14. Di Bello C, Wessells H, Mallick R, et al. Cancer-specific mortality after radical prostatectomy versus radiotherapy in incidental prostate cancer: a population-based analysis. Urol Oncol. 2024;42:1073.e1-e9."},{"key":"214818","doi-asserted-by":"crossref","unstructured":"15. Bologna G, Sanchez M, Patel V, et al. Incidental prostate cancer in patients treated for BPH: a contemporary population-based analysis. Diagnostics (Basel) 2024;14:677.","DOI":"10.3390\/diagnostics14070677"}],"container-title":["Archivio Italiano di Urologia e Andrologia"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14669\/13727","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14669\/13727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:01:05Z","timestamp":1775088065000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/view\/14669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3,31]]}},"URL":"https:\/\/doi.org\/10.4081\/aiua.2026.14669","relation":{},"ISSN":["2282-4197","1124-3562"],"issn-type":[{"value":"2282-4197","type":"electronic"},{"value":"1124-3562","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,17]]}}}