{"paper_id":"2bb6353e-1c8a-4970-9fae-15d7e67e002f","body_text":"Preoperative magnetic resonance imaging findings in the transition zone predict incidental prostate cancer in holmium laser enucleation of the prostate | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative magnetic resonance imaging findings in the transition zone predict incidental prostate cancer in holmium laser enucleation of the prostate Toshiki Ito, Yusaku Hisamatsu, Shuhei Mizutani, Takashi Kodama, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9039945/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: To assess the effectiveness of magnetic resonance imaging (MRI) of the transition zone (TZ) for predicting incidental prostate cancer (iPCa) detected after holmium laser enucleation of the prostate (HoLEP) by comparing cases with and without iPCa. Methods: We retrospectively evaluated 136 patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between June 2022 and April 2025. After excluding seven patients with biopsy-confirmed prostate cancer, data from 114 patients were analyzed and divided into two groups: iPCa (n = 17) and BPH (n = 97). The preoperative and postoperative outcomes were compared. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of iPCa. MRI assessment focused exclusively on the TZ according to the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1. Results: MRI-TZ findings (PI-RADS score of 3 or more) were significantly more prevalent in the iPCa group than in the BPH group (64.7% vs. 16.5%, p < 0.0001). Univariate analysis identified both MRI-TZ findings and prostate-specific antigen (PSA) levels greater than 6.2 ng/mL and TZ-adjusted PSA levels (PSAD-TZ) greater than 0.18 ng/mL/mL as significant predictors of iPCa. However, multivariate logistic regression identified only MRI-TZ findings as an independent predictor of iPCa (odds ratio, 8.96; 95% confidence interval: 2.68–29.9; p = 0.0004). No significant differences in postoperative urinary outcomes were observed between the two groups. Conclusion: Preoperative MRI-TZ findings may predict iPCa in patients undergoing HoLEP and potentially guide individualized perioperative risk stratification. benign prostatic hyperplasia holmium laser enucleation incidental prostate cancer Prostate Imaging-Reporting and Data System (PI-RADS) Figures Figure 1 Figure 2 Background Holmium laser enucleation of the prostate (HoLEP) has been established as a durable, size-independent surgical option for treating bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) [1–3]. However, despite careful preoperative evaluation, some patients undergoing HoLEP are diagnosed with prostate cancer based on the pathological examination of the resected tissue [4, 5]. Recent cohort studies have reported incidental prostate cancer (iPCa) rates in HoLEP specimens ranging from low single-digit to >10%. Although most iPCa cases are low-grade, clinically insignificant, and suitable for active surveillance [6–8], the rare occurrence of high-grade disease with the potential for rapid progression underscores the clinical importance of identifying patients at higher risk for significant iPCa [9]. To date, several studies have investigated predictive factors for iPCa detected after HoLEP. However, clinical predictors such as age, prostate-specific antigen (PSA) levels, PSA density (PSAD), prostate volume, and biopsy history have not been fully identified [10, 11]. Magnetic resonance imaging (MRI) is widely used for prostate cancer detection and risk stratification. A Prostate Imaging Reporting and Data System (PI-RADS) was established to estimate the likelihood of clinically significant prostate cancer. Attempts to use PI-RADS to predict incidental cancers in HoLEP have also been reported. Porecca et al. reported that the detection rate of iPCa was significantly reduced when multiparametric MRI (mpMRI) findings were negative [12]. Furthermore, Giampaoli et al. reported that a prostate biopsy can be avoided in cases with negative mpMRI findings [13]. However, to date, no studies have focused on the diagnostic accuracy of mpMRI in the transition zone (TZ), the area resected during HoLEP. This study aimed to inform individualized perioperative management strategies by retrospectively evaluating whether PI-RADS findings in the TZ could predict iPCa detection after HoLEP. Methods This study was approved by our institutional review board (R07-19) and conducted in accordance with the Declaration of Helsinki. The requirement for informed consent to publish the patient data was waived because of the retrospective nature of the study. Written informed consent was obtained from the patients at the time of treatment and was archived by the authors in accordance with their privacy rights. Population and Study Design Between June 2022 and April 2025, 136 patients underwent HoLEP for BPH at our hospital. This retrospective study included 114 patients who underwent preoperative MRI scanning and excluded seven patients with prostate cancer diagnosed by preoperative biopsy. Indications for HoLEP at our institution include persistent lower urinary tract symptoms due to BPH, acute or chronic urinary retention secondary to bladder outlet obstruction, or failure to respond to alpha-blocker and/or 5-alpha reductase inhibitor therapy. Preoperative MRI scanning was routinely conducted and evaluated using PI-RADS version 2.1 [14]. When the MRI findings suggested the possibility of prostate cancer in either the peripheral or transition zone, a prostate tissue biopsy was performed before HoLEP to rule out prostate cancer. Biopsies were performed under transrectal ultrasound guidance using a combination of systematic and targeted sampling. However, even when MRI findings suggested prostate cancer, if the patient's quality of life was significantly impaired by severe urinary symptoms or urinary tract infections, HoLEP was prioritized without performing a tissue biopsy after informing the patient of the possibility of incidental prostate cancer. MRI Assessment MRI examinations were performed using either 1.5-Tesla or 3.0-Tesla scanners. Although contrast-enhanced imaging is routinely performed at our institution, patients with renal impairment only undergo non-contrast scans. In this study, MRI findings were evaluated based on PI-RADS version 2.1 [14] and focused on the TZ, which is the area resected in HoLEP. The assessment was performed by an experienced urologist and radiologist, with a PI-RADS score <3 considered negative. Surgical Technique The HoLEP procedure was performed using a Versa Pulse™ Holmium laser system (Lumenis, Yokneam, Israel) at power settings of 75 W (2.5 kJ × 30 Hz) and a 26-Fr continuous flow resectoscope (Olympus Corporation, Tokyo, Japan) equipped with a 550-μm laser fiber (SlimLine™). Enucleation was performed according to the en bloc method previously described by our group under either general or spinal anesthesia [15]. Following the completion of the procedure, a 22-Fr three-way catheter was inserted and continuous bladder irrigation was maintained until the following morning. The catheter was removed on postoperative day 2 or 3. The perioperative anticoagulation therapy was discontinued. Statistical Analysis The 114 patients were divided into iPCa (n = 17) and BPH (n = 97) groups. The clinical characteristics and outcomes at 3 months postoperatively were compared. Age, PSA levels, TZ-adjusted PSA levels (PSAD-TZ), history of dutasteride administration (a 5α-reductase inhibitor), history of prostate biopsy, and abnormal MRI findings were selected as potential predictors of prostate cancer. Univariate and multivariate logistic regression analyses were performed. Continuous variables were dichotomized based on optimal cutoff values determined using receiver operating characteristic curve analysis. Statistical analyses were performed using MedCalc ® software (version 23.3.7), employing nonparametric tests when necessary. Statistical significance was set at p < 0.05. Results Clinical Characteristics In total, 114 patients were included in the study: 97 in the BPH group and 17 in the iPCa group. Preoperative characteristics are listed in Table 1. No significant differences were identified in the median age at surgery, PSA levels, total prostate volume, TZ volume, or urinary symptoms (International Prostate Symptom Score [or quality of life score). In addition, no significant differences were observed in the frequency of dutasteride use or prostate biopsy history between the two groups. MRI-TZ findings (PI-RADS score of ≥3) were more prevalent in the iPCa group than in the BPH group (64.7% vs. 16.5%; p < 0.0001). Figure 1 shows the frequency distributions of the two groups. Fig. 1 Percentage of MRI findings in the transition zone MRI, magnetic resonance imaging; PI-RADS, prostate imaging reporting and data system; BPH, benign prostatic hyperplasia; iPCa, incidental prostate cancer Background of MRI-TZ Findings Table 2 shows the differences between the two groups based on the MRI-TZ abnormalities. There were no significant differences in age, urinary function, or dutasteride use between the two groups. However, in the MRI-TZ positive group, PSA levels (7.9 [2.0–24.3] vs. 5.1 [0.2–28.4] ng/mL; p = 0.020) and PSAD-TZ (0.15 [0.04–0.65] vs. 0.11 [0.002–0.50] ng/mL/mL; p = 0.031) were significantly higher. Additionally, previous prostate biopsies were significantly more frequent in the MRI-TZ-positive group (44.4% vs. 13.8%; p = 0.0007), reflecting the clinical practice in which patients with MRI-TZ abnormalities underwent prostate biopsy to exclude prostate cancer before HoLEP (Figure 2). Fig. 2 Percentage of previous prostate biopsies based on the MRI-TZ findings MRI, Magnetic Resonance Imaging; TZ, transition zone. Clinical Outcomes Three months after HoLEP, no significant differences were observed in median enucleation time, enucleation weight, postoperative PSA levels, PSA reduction rate, IPSS, quality of life score, maximum flow rate, or post-void residual volume (Table 3). Predictive Factors In the univariate analysis, MRI-TZ abnormalities (odds ratio [OR] 9.28, p = 0.0001), PSAD-TZ greater than 0.18 ng/mL/mL (OR 3.19, p = 0.033), and PSA levels greater than 6.2 ng/mL (OR 3.36, p=0.026) were identified as significant predictors of iPCa. However, in multivariate analysis, only MRI-TZ abnormalities remained a significant predictor (OR 8.96, p = 0.0004) (Table 4). Discussion HoLEP has emerged as the gold standard surgical treatment for BPH, offering superior outcomes compared to traditional transurethral resection of the prostate or open prostatectomy. Multiple studies have demonstrated that HoLEP provides excellent efficacy regardless of prostate size, with improved urinary outcomes, lower morbidity, reduced reoperation rates, and fewer perioperative complications [ 1 – 3 ]. Concurrently, increasing attention has been directed toward iPCa detected following large-volume adenoma resection [ 4 , 5 ]. The detection rate of iPCa after HoLEP varies across studies, but most cases involve low-risk tumors that can be managed with active surveillance [ 6 – 8 ]. However, as severe cases occasionally require immediate treatment [ 9 ], it is important to predict oncological risks before surgery. Tissue diagnosis using prostate biopsy is necessary to exclude prostate cancer preoperatively in patients who are candidates for HoLEP. However, in patients with severe urinary retention, urinary tract infection, or catheter-dependent obstruction, complications associated with prostate biopsy may delay surgical intervention [ 16 – 18 ]. Under these circumstances, a strategy allowing early HoLEP without prostate biopsy, provided the oncological risk is acceptable, holds clinical value. Several reports have suggested that older age, elevated total PSA levels, and increased PSA density may be potential risk factors [ 4 , 8 , 10 , 11 ]. However, no established predictive factors exist, and the significance of preoperative prostate biopsy remains unclear [ 10 , 19 ]. MRI has recently become a widely used tool for detecting prostate cancer and for risk stratification. The PI-RADS was established to estimate the likelihood of clinically significant prostate cancer. It was introduced in 2012 [ 20 ], updated to version 2.0, in 2015 [ 21 ], and progressed to version 2.1 2019 [ 14 ], thereby improving the detection rates of clinically significant prostate cancer [ 22 , 23 ]. Recent reports examining the role of MRI in HoLEP candidates suggest that negative multiparametric MRI findings may be associated with lower iPCa incidence than evaluations based solely on prostate biopsy [ 12 , 13 , 24 ]. Furthermore, some studies have suggested that MRI lesions with high PI-RADS scores (4–5) are strongly associated with prostate cancer detection in patients scheduled for HoLEP [ 24 ]. In contrast, more recent data suggest that the presence or location of PI-RADS lesions alone does not clearly correlate with the incidence or grade of iPCa in HoLEP pathology, implying that MRI findings alone may be insufficient to accurately predict incidental diseases [ 25 ]. Several studies have attempted to stratify risk using other clinical parameters, such as age, PSA levels, PSAD, and prostate volume, to improve the diagnostic accuracy of MRI. Li et al. reported that combining PSAD with the PI-RADS v2.1 score helped improve the diagnostic accuracy of prostate cancer and avoid unnecessary biopsies [ 26 ]. Zheng et al. demonstrated that the PSA density in the TZ is more accurate than PSA density of the total prostate volume for diagnosing prostate cancer during prostate biopsy. Accordingly, the present study adopted PSAD-TZ as a predictor of incidental prostate cancer [ 27 ]. In this study, univariate analysis results demonstrated that abnormal MRI-TZ findings, PSAD scores greater than 0.18 ng/mL/mL, and PSA levels greater than 6.2 ng/mL, were significant predictors of iPCa. Notably, multivariate analysis identified abnormal MRI-TZ findings as the sole independent predictor of iPCa. These results suggest that preoperative MRI evaluation provides valuable risk stratification beyond conventional clinical parameters. Additionally, these findings suggest the importance of a combined model using PSAD-TZ, because the discriminatory power of MRI scans alone is limited [ 26 ]. Furthermore, our analysis found no significant differences in the postoperative urinary function or short-term oncological outcomes between patients with and without iPCa. For patients with BPH, it is often necessary to urgently treat severe lower urinary tract symptoms or complications, while excluding clinically significant prostate cancer. The present study is clinically significant, suggesting that most prostate cancers detected using HoLEP are low grade and do not adversely affect immediate postoperative recovery or short-term outcomes. The results of this study support the use of preoperative MRI scanning as a tool for the risk stratification of patients undergoing HoLEP. By predicting the likelihood of incidental prostate cancer, preoperative MRI enables individualized decision making regarding whether to prioritize prostate biopsy for cancer diagnosis or proceed directly with surgical intervention for symptom relief. Limitations This study has several limitations. First, it was based on a retrospective analysis, introducing selection bias due to the exclusion of patients with prostate cancer. Specifically, because only TZ tissue obtained from HoLEP was evaluated, cases with abnormal findings in the peripheral zone on MRI or suspected prostate cancer may have been diagnosed with prostate cancer and were excluded from the study. Therefore, further evaluation of the long-term oncological outcomes is required. Second, the limited number of observations and the lack of matching between the two groups compromised the statistical power of the analysis. Third, interobserver variability could not be eliminated in all PI-RADS assessments. Furthermore, non-contrast MRI in patients with renal impairment may also affect the accuracy of PI-RADS. Finally, the variable selection in this multivariate logistic regression model was subjective, potentially omitting important variables. Despite these limitations, this study demonstrated that abnormal MRI findings in the TZ are important predictors of iPCa before HoLEP and are readily applicable in clinical practice. Future large-scale prospective cohort studies with longer follow-up periods are needed to establish a comprehensive oncological risk stratification. Such studies may facilitate the simultaneous achievement of severe lower urinary tract symptom improvement with HoLEP and optimal prostate cancer management in patients with BPH and prostate cancer. Conclusions Our findings show that preoperative MRI can predict iPCa detection in the TZ prior to HoLEP. Although the early follow-up data did not reveal significant differences in oncological outcomes, our findings suggest that a risk-stratified surveillance strategy based on preoperative MRI findings should be considered to optimize long-term cancer management in patients undergoing HoLEP. Abbreviations BPH Benign prostatic hyperplasia HoLEP Holmium laser enucleation of the prostate iPCa Incidental prostate cancer IPSS International Prostate Symptom Score MRI Magnetic resonance imaging mpMRI Multiparametric magnetic resonance imaging OR Odds ratio PI-RADS Prostate Imaging-Reporting and Data System PSA Prostate-specific antigen PSAD PSA density PSAD-TZ PSA density of the transition zone PVR Post-void residual QoL Quality of life Qmax Maximum flow rate TPV Total prostate volume TZ Transition zone TZV Transition zone volume. Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board (R07-19) and conducted in accordance with the Declaration of Helsinki. Consent for publication The requirement for informed consent to publish the patient data was waived because of the retrospective nature of the study. Competing interests The authors have no competing interests to declare. Authors’ contributions Toshiki Ito: project administration, conceptualization, methodology, data collection, data analysis, and writing of the original draft. Yusaku Hisamatsu, Shuhei Mizutani, Takashi Kodama, Shinya Watanabe and Hiroyuki Amano: Data collection. Teruo Inamoto: Writing, review, editing, and supervision. All the authors have read and approved the final manuscript. Funding This study did not receive any funding. Acknowledgements Not applicable Availability of data and materials The datasets generated or analyzed in the current study are available from the corresponding author upon reasonable request. References Michalak J, Tzou D, Funk J (2015) HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol 3:36–42 Chen F, Chen Y, Zou Y, Wang Y, Wu X, Chen M (2023) Comparison of holmium laser enucleation and transurethral resection of prostate in benign prostatic hyperplasia: a systematic review and meta-analysis. 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Preoperative characteristic of patients with and without incidental prostate cancer following HoLEP Variable Overall (n =114) BPH (n=97) IPCa (n=17) p value Age, years (Median, range) 75 (56-98) 75 (56-98) 76 (62-85) 0.29 PSA, ng/ml (Median, range) 5.4 (0.2-28.4) 5.2 (0.2-28.3) 7.2 (1.4-20.9) 0.09 TPV, ml (Median, range) 73 (15-230) 73 (15-230) 80 (34-160) 0.75 TZV, ml (Median, range) 50 (7-200) 50 (13-200) 50 (20-100) 0.81 PSAD-TZ, ng/ml/mll (Median, range) 0.11 (0.012-0.65) 0.11 (0.012-0.65) 0.19 (0.04-0.47) 0.18 IPSS (Median, range) 14 (1-35) 14 (1-35) 15 (0-34) 0.32 QoL score (Median, range) 4 (1-6) 4 (1-6) 5 (3-6) 0.50 Qmax, ml/sec 7.5 (2.6-19.5) 7.0 (2.6-16.6) 8.6 (3.5-19.5) 0.24 PVR, ml (Median, range) 91 (0-750) 104 (0-750) 67 (12-158) 0.01 Dutasteride, n (%) Yes 32 (28.1) 27 (28.1) 5 (29.4) 0.91 No 82 (71.9) 69 (71.9) 12 (70.6) Previous prostate biopsy, n (%) Yes 24 (21.1) 20 (20.6) 4 (23.5) 0.79 No 90 (78.9) 77 (79.4) 13 (76.5) MRI findings in TZ, n (%) Negative 87 (76.3) 81 (83.5) 6 (35.3) < 0.001 PIRADS 3 15 (13.2) 10 (10.3) 5 (29.4) PIRADS 4 12 (10.5) 6 (6.2) 6 (35.3) HoLEP = holmium laser enucleation of the prostate; PSA= prostate-specific antigen; TPV=total prostate volume; TZV=transition zone volume; TZ= transition zone; PSAD-TZ=PSA density of TZ; IPSS = International Prostate Symptom Score; QoL = quality of life; Qmax = maximum flow rate; PVR = postvoid residual; MRI=magnetic resonance imaging; BPH=benign prostatic hyperplasia; iPCa=incidental prostate cancer Table 2. Preoperative characteristic of patients with and without MRI-TZ findings Variable Overall (n =114) MRI-TZ: Negative (n=87) MRI-TZ: Positive (n=27) p value Age, years (Median, range) 75 (56-98) 75 (56-98) 75 (60-87) 0.95 PSA, ng/ml (Median, range) 5.4 (0.2-28.4) 5.1 (0.2-28.4) 7.9 (2.0-24.3) 0.020 TPV, ml (Median, range) 73 (15-230) 70 (20-230) 79 (15-112) 0.50 TZV, ml (Median, range) 50 (7-200) 50 (7-200) 50 (20-90) 0.60 PSAD-TZ, ng/ml/mll (Median, range) 0.11 (0.002-0.65) 0.11 (0.002-0.50) 0.15 (0.04-0.65) 0.031 IPSS (Median, range) 14 (1-35) 13 (1-34) 18 (6-35) 0.11 QoL score (Median, range) 4 (1-6) 4 (1-6) 4 (2-6) 0.81 Qmax, ml/sec 7.5 (2.6-19.5) 7.3 (2.6-16.6) 8.1 (3.5-19.5) 0.83 PVR, ml (Median, range) 91 (0-750) 100 (0-600) 67 (12-750) 0.12 Dutasteride, n (%) Yes 32 (28.1) 26 (29.9) 6 (22.2) 0.46 No 82 (71.9) 61 (70.1) 21 (77.8) Previous prostate biopsy, n (%) Yes 24 (21.1) 12 (13.8) 12 (44.4) 0.0007 No 90 (78.9) 75 (86.2) 15 (55.6) MRI=magnetic resonance imaging; TZ= transition zone; PSA= prostate-specific antigen; TPV=total prostate volume; TZV=transition zone volume; IPSS = International Prostate Symptom Score; QoL = quality of life; Qmax = maximum flow rate; PVR = postvoid residual Table 3. Preoperative surgical and clinical outcomes 3months after HoLEP Variable Overall (n =114) BPH (n=97) IPCa (n=17) p value Enucleation time, min (Median, range) 39 (18-110) 39 (18-110) 39 (18-82) 0.79 Enucleation weight, g (Median, range) 41 (4-117) 40 (4-117) 36 (12-90) 0.63 Postoperative PSA, ng/ml/ml (Median, range) 0.41 (0.03-3.83) 0.37 (0.03-3.83) 0.48 (0.04-3.66) 0.47 PSA reduction rate (Median, range) 92.3 (-14.9-99.2) 92.3 (-14.9-98.9) 91.2 (60.9-99.2) 0.92 IPSS (Median, range) 7 (1-26) 7 (1-26) 7 (1-23) 0.44 QoL score (Median, range) 2 (0-6) 2 (0-6) 3 (0-6) 0.11 Qmax, ml/sec 16.7 (2.6-49.2) 17.8 (2.6-49.2) 15.1 (4.6-31.6) 0.19 PVR, ml (Median, range) 38 (0-234) 33 (0-234) 22 (0-60) 0.17 HoLEP = holmium laser enucleation of the prostate; PSA= prostate-specific antigen; IPSS = International Prostate Symptom Score; QoL = quality of life; Qmax = maximum flow rate; PVR = postvoid residual; BPH=benign prostatic hyperplasia; iPCa=incidental prostate cancer Table 4. Logistic regression assessing clinical factors associated with incidental prostate cancer diagnosis after HoLEP Univariate analysis Multivariate analysis Odds ratio 95% CI P Odds ratio 95% CI P Age >75, years (yes vs. no) 2.40 0.86 to 7.39 0.10 PSA >6.2, ng/ml (yes vs. no) 3.36 1.10 to 10.29 0.026 1.10 0.24 to 4.98 0.89 PSAD-TZ > 0.18, ng/ml/ml (yes vs. no) 3.19 1.11 to 9.20 0.033 2.88 0.68 to 12.2 0.15 Dutasteride (yes vs. no) 1.06 0.34 to 3.31 0.91 Previous prostate biopsy (yes vs. no) 1.18 0.35 to 4.03 0.79 MRI findings in TZ (yes vs. no) 9.28 2.99 to 28.7 0.0001 8.96 2.68 to 29.9 0.0004 HoLEP = holmium laser enucleation of the prostate; PSA= prostate-specific antigen; TZ=transition zone; PSAD-TZ=PSA density of TZ; MRI=magnetic resonance imaging Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9039945\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":602276209,\"identity\":\"c5a2d55b-5cea-436d-b7c0-5cd272ddea25\",\"order_by\":0,\"name\":\"Toshiki Ito\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYFACNgaGBAMJOSCL8QCQSVgDD0jLgwIbYwYGZgbitTA++JCW2EC0Fnv+YwlAhx1O75fIP3DgQ0UaA397N359PBJpB0BacmfOSGY4OONMDoPEmbMbCGhhb/8B0rLhRjLDYd62CgYDiVwCWviPN4AdZkC8Fgaww9ISoFpyiNByIw3kfRvDmT2PDYB+SeMh6Bf2/mMGjD/+SMjzsyc+fPChIlmOv70XvxYsLh0Fo2AUjIJRQDkAANpQRr3PnhFWAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Fujieda Municipal General Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Toshiki\",\"middleName\":\"\",\"lastName\":\"Ito\",\"suffix\":\"\"},{\"id\":602276211,\"identity\":\"92320db0-98da-432a-a857-f55c095c8f7b\",\"order_by\":1,\"name\":\"Yusaku Hisamatsu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Fujieda Municipal General Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yusaku\",\"middleName\":\"\",\"lastName\":\"Hisamatsu\",\"suffix\":\"\"},{\"id\":602276212,\"identity\":\"68fa5b01-6620-4e8d-8959-04d15b4f4e7f\",\"order_by\":2,\"name\":\"Shuhei Mizutani\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Fujieda Municipal General Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shuhei\",\"middleName\":\"\",\"lastName\":\"Mizutani\",\"suffix\":\"\"},{\"id\":602276213,\"identity\":\"7b4c7be8-5adb-410c-8d47-360e3889baf3\",\"order_by\":3,\"name\":\"Takashi Kodama\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Fujieda Municipal General Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Takashi\",\"middleName\":\"\",\"lastName\":\"Kodama\",\"suffix\":\"\"},{\"id\":602276217,\"identity\":\"4f676a86-4b12-4ef9-87b2-acbe59f3dbb7\",\"order_by\":4,\"name\":\"Shinya Watanabe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Fujieda Municipal General Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shinya\",\"middleName\":\"\",\"lastName\":\"Watanabe\",\"suffix\":\"\"},{\"id\":602276218,\"identity\":\"0637fb0d-34d2-4212-b87e-93ce94180a30\",\"order_by\":5,\"name\":\"Hiroyuki Amano\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Amano Clinic\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hiroyuki\",\"middleName\":\"\",\"lastName\":\"Amano\",\"suffix\":\"\"},{\"id\":602276220,\"identity\":\"333c75fa-f5f6-4137-8fd4-058988b43dc0\",\"order_by\":6,\"name\":\"Teruo Inamoto\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hamamatsu University School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Teruo\",\"middleName\":\"\",\"lastName\":\"Inamoto\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-03-05 12:24:26\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9039945/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9039945/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":104338561,\"identity\":\"68cc0f70-ba53-4327-93e6-f00c14518db8\",\"added_by\":\"auto\",\"created_at\":\"2026-03-10 16:22:07\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":39893,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePercentage of MRI findings in the transition zone\\u003c/p\\u003e\\n\\u003cp\\u003eMRI, magnetic resonance imaging; PI-RADS, prostate imaging reporting and data system; BPH, benign prostatic hyperplasia; iPCa, incidental prostate cancer\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9039945/v1/89d7b81e107df43cfc7844f6.png\"},{\"id\":104338562,\"identity\":\"68a47efb-9e80-4194-b1fc-7d4b1b8e97ba\",\"added_by\":\"auto\",\"created_at\":\"2026-03-10 16:22:08\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":42916,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePercentage of previous prostate biopsies based on the MRI-TZ findings MRI, Magnetic Resonance Imaging; TZ, transition zone.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9039945/v1/76871a97e98e327039e0632e.png\"},{\"id\":108587953,\"identity\":\"9413fd4b-fc45-438c-8cec-adbef34e4ab7\",\"added_by\":\"auto\",\"created_at\":\"2026-05-06 09:12:43\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":431226,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9039945/v1/d803a278-34d4-4035-90e8-71f671c4e7d1.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Preoperative magnetic resonance imaging findings in the transition zone predict incidental prostate cancer in holmium laser enucleation of the prostate\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eHolmium laser enucleation of the prostate (HoLEP) has been established as a durable, size-independent surgical option for treating bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) [1\\u0026ndash;3]. However, despite careful preoperative evaluation, some patients undergoing HoLEP are diagnosed with prostate cancer based on the pathological examination of the resected tissue [4, 5].\\u003c/p\\u003e\\n\\u003cp\\u003eRecent cohort studies have reported incidental prostate cancer (iPCa) rates in HoLEP specimens ranging from low single-digit to \\u0026gt;10%. Although most iPCa cases are low-grade, clinically insignificant, and suitable for active surveillance [6\\u0026ndash;8], the rare occurrence of high-grade disease with the potential for rapid progression underscores the clinical importance of identifying patients at higher risk for significant iPCa [9].\\u003c/p\\u003e\\n\\u003cp\\u003eTo date, several studies have investigated predictive factors for iPCa detected after HoLEP. However, clinical predictors such as age, prostate-specific antigen (PSA) levels, PSA density (PSAD), prostate volume, and biopsy history have not been fully identified [10, 11].\\u003c/p\\u003e\\n\\u003cp\\u003eMagnetic resonance imaging (MRI) is widely used for prostate cancer detection and risk stratification. A Prostate Imaging Reporting and Data System (PI-RADS) was established to estimate the likelihood of clinically significant prostate cancer. Attempts to use PI-RADS to predict incidental cancers in HoLEP have also been reported. Porecca et al. reported that the detection rate of iPCa was significantly reduced when multiparametric MRI (mpMRI) findings were negative [12]. Furthermore, Giampaoli et al. reported that a prostate biopsy can be avoided in cases with negative mpMRI findings [13]. However, to date, no studies have focused on the diagnostic accuracy of mpMRI in the transition zone (TZ), the area resected during HoLEP.\\u003c/p\\u003e\\n\\u003cp\\u003eThis study aimed to inform individualized perioperative management strategies by retrospectively evaluating whether PI-RADS findings in the TZ could predict iPCa detection after HoLEP.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThis study was approved by our institutional review board (R07-19) and conducted in accordance with the Declaration of Helsinki. The requirement for informed consent to publish the patient data was waived because of the retrospective nature of the study. Written informed consent was obtained from the patients at the time of treatment and was archived by the authors in accordance with their privacy rights.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePopulation and Study Design\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBetween June 2022 and April 2025, 136 patients underwent HoLEP for BPH at our hospital. This retrospective study included 114 patients who underwent preoperative MRI scanning and excluded seven patients with prostate cancer diagnosed by preoperative biopsy.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIndications for HoLEP at our institution include persistent lower urinary tract symptoms due to BPH, acute or chronic urinary retention secondary to bladder outlet obstruction, or failure to respond to alpha-blocker and/or 5-alpha reductase inhibitor therapy. Preoperative MRI scanning was routinely conducted and evaluated using PI-RADS version 2.1 [14]. When the MRI findings suggested the possibility of prostate cancer in either the peripheral or transition zone, a prostate tissue biopsy was performed before HoLEP to rule out prostate cancer. Biopsies were performed under transrectal ultrasound guidance using a combination of systematic and targeted sampling. However, even when MRI findings suggested prostate cancer, if the patient\\u0026apos;s quality of life was significantly impaired by severe urinary symptoms or urinary tract infections, HoLEP was prioritized without performing a tissue biopsy after informing the patient of the possibility of incidental prostate cancer.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMRI Assessment\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMRI examinations were performed using either 1.5-Tesla or 3.0-Tesla scanners. Although contrast-enhanced imaging is routinely performed at our institution, patients with renal impairment only undergo non-contrast scans. In this study, MRI findings were evaluated based on PI-RADS version 2.1 [14] and focused on the TZ, which is the area resected in HoLEP. The assessment was performed by an experienced urologist and radiologist, with a PI-RADS score \\u0026lt;3 considered negative.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSurgical Technique\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe HoLEP procedure was performed using a Versa Pulse\\u0026trade; Holmium laser system (Lumenis, Yokneam, Israel) at power settings of 75 W (2.5 kJ \\u0026times; 30 Hz) and a 26-Fr continuous flow resectoscope (Olympus Corporation, Tokyo, Japan) equipped with a 550-\\u0026mu;m laser fiber (SlimLine\\u0026trade;). Enucleation was performed according to the en bloc method previously described by our group under either general or spinal anesthesia [15]. Following the completion of the procedure, a 22-Fr three-way catheter was inserted and continuous bladder irrigation was maintained until the following morning. The catheter was removed on postoperative day 2 or 3. The perioperative anticoagulation therapy was discontinued.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe 114 patients were divided into iPCa (n = 17) and BPH (n = 97) groups. The clinical characteristics and outcomes at 3 months postoperatively were compared. Age, PSA levels, TZ-adjusted PSA levels (PSAD-TZ), history of dutasteride administration (a 5\\u0026alpha;-reductase inhibitor), history of prostate biopsy, and abnormal MRI findings were selected as potential predictors of prostate cancer. Univariate and multivariate logistic regression analyses were performed. Continuous variables were dichotomized based on optimal cutoff values determined using receiver operating characteristic curve analysis.\\u003c/p\\u003e\\n\\u003cp\\u003eStatistical analyses were performed using MedCalc\\u003csup\\u003e\\u0026reg;\\u003c/sup\\u003e software (version 23.3.7), employing nonparametric tests when necessary. Statistical significance was set at p \\u0026lt; 0.05.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eClinical Characteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn total, 114 patients were included in the study: 97 in the BPH group and 17 in the iPCa group. Preoperative characteristics are listed in Table 1. No significant differences were identified in the median age at surgery, PSA levels, total prostate volume, TZ volume, or urinary symptoms (International Prostate Symptom Score [or quality of life score). In addition, no significant differences were observed in the frequency of dutasteride use or prostate biopsy history between the two groups. MRI-TZ findings (PI-RADS score of \\u0026ge;3) were more prevalent in the iPCa group than in the BPH group (64.7% vs. 16.5%; p \\u0026lt; 0.0001). Figure 1 shows the frequency distributions of the two groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFig. 1\\u003c/strong\\u003e Percentage of MRI findings in the transition zone\\u003c/p\\u003e\\n\\u003cp\\u003eMRI, magnetic resonance imaging; PI-RADS, prostate imaging reporting and data system; BPH, benign prostatic hyperplasia; iPCa, incidental prostate cancer\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBackground of MRI-TZ Findings\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable 2 shows the differences between the two groups based on the MRI-TZ abnormalities. There were no significant differences in age, urinary function, or dutasteride use between the two groups. However, in the MRI-TZ positive group, PSA levels (7.9 [2.0\\u0026ndash;24.3] vs. 5.1 [0.2\\u0026ndash;28.4] ng/mL; p = 0.020) and PSAD-TZ (0.15 [0.04\\u0026ndash;0.65] vs. 0.11 [0.002\\u0026ndash;0.50] ng/mL/mL; p = 0.031) were significantly higher. Additionally, previous prostate biopsies were significantly more frequent in the MRI-TZ-positive group (44.4% vs. 13.8%; p = 0.0007), reflecting the clinical practice in which patients with MRI-TZ abnormalities underwent prostate biopsy to exclude prostate cancer before HoLEP (Figure 2).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFig. 2\\u003c/strong\\u003e Percentage of previous prostate biopsies based on the MRI-TZ findings\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eMRI, Magnetic Resonance Imaging; TZ, transition zone.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical Outcomes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThree months after HoLEP, no significant differences were observed in median enucleation time, enucleation weight, postoperative PSA levels, PSA reduction rate, IPSS, quality of life score, maximum flow rate, or post-void residual volume (Table 3).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePredictive Factors\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn the univariate analysis, MRI-TZ abnormalities (odds ratio [OR] 9.28, p = 0.0001), PSAD-TZ greater than 0.18 ng/mL/mL (OR 3.19, p = 0.033), and PSA levels greater than 6.2 ng/mL (OR 3.36, p=0.026) were identified as significant predictors of iPCa. However, in multivariate analysis, only MRI-TZ abnormalities remained a significant predictor (OR 8.96, p = 0.0004) (Table 4).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eHoLEP has emerged as the gold standard surgical treatment for BPH, offering superior outcomes compared to traditional transurethral resection of the prostate or open prostatectomy. Multiple studies have demonstrated that HoLEP provides excellent efficacy regardless of prostate size, with improved urinary outcomes, lower morbidity, reduced reoperation rates, and fewer perioperative complications [\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Concurrently, increasing attention has been directed toward iPCa detected following large-volume adenoma resection [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The detection rate of iPCa after HoLEP varies across studies, but most cases involve low-risk tumors that can be managed with active surveillance [\\u003cspan additionalcitationids=\\\"CR7\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. However, as severe cases occasionally require immediate treatment [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], it is important to predict oncological risks before surgery.\\u003c/p\\u003e \\u003cp\\u003eTissue diagnosis using prostate biopsy is necessary to exclude prostate cancer preoperatively in patients who are candidates for HoLEP. However, in patients with severe urinary retention, urinary tract infection, or catheter-dependent obstruction, complications associated with prostate biopsy may delay surgical intervention [\\u003cspan additionalcitationids=\\\"CR17\\\" citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Under these circumstances, a strategy allowing early HoLEP without prostate biopsy, provided the oncological risk is acceptable, holds clinical value.\\u003c/p\\u003e \\u003cp\\u003eSeveral reports have suggested that older age, elevated total PSA levels, and increased PSA density may be potential risk factors [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. However, no established predictive factors exist, and the significance of preoperative prostate biopsy remains unclear [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eMRI has recently become a widely used tool for detecting prostate cancer and for risk stratification. The PI-RADS was established to estimate the likelihood of clinically significant prostate cancer. It was introduced in 2012 [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], updated to version 2.0, in 2015 [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e], and progressed to version 2.1 2019 [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e], thereby improving the detection rates of clinically significant prostate cancer [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Recent reports examining the role of MRI in HoLEP candidates suggest that negative multiparametric MRI findings may be associated with lower iPCa incidence than evaluations based solely on prostate biopsy [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Furthermore, some studies have suggested that MRI lesions with high PI-RADS scores (4\\u0026ndash;5) are strongly associated with prostate cancer detection in patients scheduled for HoLEP [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. In contrast, more recent data suggest that the presence or location of PI-RADS lesions alone does not clearly correlate with the incidence or grade of iPCa in HoLEP pathology, implying that MRI findings alone may be insufficient to accurately predict incidental diseases [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. Several studies have attempted to stratify risk using other clinical parameters, such as age, PSA levels, PSAD, and prostate volume, to improve the diagnostic accuracy of MRI. Li et al. reported that combining PSAD with the PI-RADS v2.1 score helped improve the diagnostic accuracy of prostate cancer and avoid unnecessary biopsies [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. Zheng et al. demonstrated that the PSA density in the TZ is more accurate than PSA density of the total prostate volume for diagnosing prostate cancer during prostate biopsy. Accordingly, the present study adopted PSAD-TZ as a predictor of incidental prostate cancer [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn this study, univariate analysis results demonstrated that abnormal MRI-TZ findings, PSAD scores greater than 0.18 ng/mL/mL, and PSA levels greater than 6.2 ng/mL, were significant predictors of iPCa. Notably, multivariate analysis identified abnormal MRI-TZ findings as the sole independent predictor of iPCa. These results suggest that preoperative MRI evaluation provides valuable risk stratification beyond conventional clinical parameters. Additionally, these findings suggest the importance of a combined model using PSAD-TZ, because the discriminatory power of MRI scans alone is limited [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. Furthermore, our analysis found no significant differences in the postoperative urinary function or short-term oncological outcomes between patients with and without iPCa. For patients with BPH, it is often necessary to urgently treat severe lower urinary tract symptoms or complications, while excluding clinically significant prostate cancer. The present study is clinically significant, suggesting that most prostate cancers detected using HoLEP are low grade and do not adversely affect immediate postoperative recovery or short-term outcomes.\\u003c/p\\u003e \\u003cp\\u003eThe results of this study support the use of preoperative MRI scanning as a tool for the risk stratification of patients undergoing HoLEP. By predicting the likelihood of incidental prostate cancer, preoperative MRI enables individualized decision making regarding whether to prioritize prostate biopsy for cancer diagnosis or proceed directly with surgical intervention for symptom relief.\\u003c/p\\u003e\\n\\u003ch3\\u003eLimitations\\u003c/h3\\u003e\\n\\u003cp\\u003eThis study has several limitations. First, it was based on a retrospective analysis, introducing selection bias due to the exclusion of patients with prostate cancer. Specifically, because only TZ tissue obtained from HoLEP was evaluated, cases with abnormal findings in the peripheral zone on MRI or suspected prostate cancer may have been diagnosed with prostate cancer and were excluded from the study. Therefore, further evaluation of the long-term oncological outcomes is required. Second, the limited number of observations and the lack of matching between the two groups compromised the statistical power of the analysis. Third, interobserver variability could not be eliminated in all PI-RADS assessments. Furthermore, non-contrast MRI in patients with renal impairment may also affect the accuracy of PI-RADS. Finally, the variable selection in this multivariate logistic regression model was subjective, potentially omitting important variables.\\u003c/p\\u003e \\u003cp\\u003eDespite these limitations, this study demonstrated that abnormal MRI findings in the TZ are important predictors of iPCa before HoLEP and are readily applicable in clinical practice. Future large-scale prospective cohort studies with longer follow-up periods are needed to establish a comprehensive oncological risk stratification. Such studies may facilitate the simultaneous achievement of severe lower urinary tract symptom improvement with HoLEP and optimal prostate cancer management in patients with BPH and prostate cancer.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eOur findings show that preoperative MRI can predict iPCa detection in the TZ prior to HoLEP. Although the early follow-up data did not reveal significant differences in oncological outcomes, our findings suggest that a risk-stratified surveillance strategy based on preoperative MRI findings should be considered to optimize long-term cancer management in patients undergoing HoLEP.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eBPH\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eBenign prostatic hyperplasia\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHoLEP\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHolmium laser enucleation of the prostate\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eiPCa\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eIncidental prostate cancer\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIPSS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eInternational Prostate Symptom Score\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eMRI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMagnetic resonance imaging\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003empMRI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMultiparametric magnetic resonance imaging\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eOR\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eOdds ratio\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePI-RADS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eProstate Imaging-Reporting and Data System\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePSA\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eProstate-specific antigen\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePSAD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePSA density\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePSAD-TZ\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePSA density of the transition zone\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePVR\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePost-void residual\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eQoL\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eQuality of life\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eQmax\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMaximum flow rate\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eTPV\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eTotal prostate volume\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eTZ\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eTransition zone\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eTZV\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eTransition zone volume.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the Institutional Review Board (R07-19) and conducted in accordance with the Declaration of Helsinki.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe requirement for informed consent to publish the patient data was waived because of the retrospective nature of the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors have no competing interests to declare.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors’ contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eToshiki Ito: project administration, conceptualization, methodology, data collection, data analysis, and writing of the original draft. Yusaku Hisamatsu, Shuhei Mizutani, Takashi Kodama, Shinya Watanabe and Hiroyuki Amano: Data collection. Teruo Inamoto: Writing, review, editing, and supervision. All the authors have read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study did not receive any funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated or analyzed in the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eMichalak J, Tzou D, Funk J (2015) HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol 3:36\\u0026ndash;42\\u003c/li\\u003e\\n \\u003cli\\u003eChen F, Chen Y, Zou Y, Wang Y, Wu X, Chen M (2023) Comparison of holmium laser enucleation and transurethral resection of prostate in benign prostatic hyperplasia: a systematic review and meta-analysis. J Int Med Res 51:3000605231190763. https://doi.org/10.1177/03000605231190763\\u003c/li\\u003e\\n \\u003cli\\u003eKuntz RM, Lehrich K, Ahyai S (2004) Does perioperative outcome of transurethral holmium laser enucleation of the prostate depend on prostate size? J Endourol 18:183\\u0026ndash;188. https://doi.org/10.1089/089277904322959842\\u003c/li\\u003e\\n \\u003cli\\u003eSakai A, Borza T, Antar A, Richmond E, Allen GO, Knoedler M, et al (2024) Incidental prostate cancer diagnosis is common after holmium laser enucleation of the prostate. Urology 183:170\\u0026ndash;175. https://doi.org/10.1016/j.urology.2023.11.014\\u003c/li\\u003e\\n \\u003cli\\u003eYilmaz M, Toprak T, Suarez-Ibarrola R, Sigle A, Gratzke C, Miernik A (2022) Incidental prostate cancer after holmium laser enucleation of the prostate-A narrative review. Andrologia 54:e14332. https://doi.org/10.1111/and.14332\\u003c/li\\u003e\\n \\u003cli\\u003eTominaga Y, Sadahira T, Mitsui Y, Maruyama Y, Tanimoto R, Wada K, et al (2019) Favorable long-term oncological and urinary outcomes of incidental prostate cancer following holmium laser enucleation of the prostate. Mol Clin Oncol 10:605\\u0026ndash;609. https://doi.org/10.3892/mco.2019.1839\\u003c/li\\u003e\\n \\u003cli\\u003eNunez R, Hurd KJ, Noble BN, Castle EP, Andrews PE, Humphreys MR (2011) Incidental prostate cancer revisited: early outcomes after holmium laser enucleation of the prostate. Int J Urol 18:543\\u0026ndash;547. https://doi.org/10.1111/j.1442-2042.2011.02776.x\\u003c/li\\u003e\\n \\u003cli\\u003eElkoushy MA, Elshal AM, Elhilali MM (2015) Incidental prostate cancer diagnosis during holmium laser enucleation: assessment of predictors, survival, and disease progression. Urology 86:552\\u0026ndash;557. https://doi.org/10.1016/j.urology.2015.06.002\\u003c/li\\u003e\\n \\u003cli\\u003eKoguchi D, Nishi M, Satoh T, Shitara T, Matsumoto K, Fujita T, et al (2014) Bone dissemination of prostate cancer after holmium laser enucleation of the prostate: a case report and a review of the literature. Int J Urol 21:215\\u0026ndash;217. https://doi.org/10.1111/iju.12248\\u003c/li\\u003e\\n \\u003cli\\u003eWang Y, Li X, Yang H, Yin C, Wu Y, Chen X (2025) Predictive factors of incidental prostate cancer in patients undergoing surgery for presumed benign prostatic hyperplasia: an updated systematic review and meta-analysis. Front Oncol 15:1561675. https://doi.org/10.3389/fonc.2025.1561675\\u003c/li\\u003e\\n \\u003cli\\u003eHerlemann A, Wegner K, Roosen A, Buchner A, Weinhold P, Bachmann A, et al (2017) \\u0026lsquo;Finding the needle in a haystack\\u0026rsquo;: oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP). World J Urol 35:1777\\u0026ndash;1782. https://doi.org/10.1007/s00345-017-2048-y\\u003c/li\\u003e\\n \\u003cli\\u003ePorreca A, Giampaoli M, Bianchi L, D\\u0026rsquo;Agostino D, Romagnoli D, Bianchi FM, et al (2019) Preoperative multiparametric prostate magnetic resonance imaging: a safe clinical practice to reduce incidental prostate cancer in holmium laser enucleation of the prostate. Cent Eur J Urol 72:106\\u0026ndash;112. https://doi.org/10.5173/ceju.2019.1943\\u003c/li\\u003e\\n \\u003cli\\u003eGiampaoli M, Bianchi L, D\\u0026rsquo;Agostino D, Corsi P, Romagnoli D, Mineo Bianchi F, et al (2019) Can preoperative multiparametric MRI avoid unnecessary prostate biopsies before holmium laser enucleation of the prostate? Preliminary results of a multicentric cohort of patients. Minerva Urol Nefrol = Minerva Urol Nefrol 71:524\\u0026ndash;530. https://doi.org/10.23736/S0393-2249.19.03463-5\\u003c/li\\u003e\\n \\u003cli\\u003eTurkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al (2019) Prostate imaging reporting and data system, version 2.1 Update of (2019) Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 76:340\\u0026ndash;351. https://doi.org/10.1016/j.eururo.2019.02.033\\u003c/li\\u003e\\n \\u003cli\\u003eIto T, Tamura K, Otsuka A, Shinbo H, Takada S, Kurita Y, Miyake H (2019) Development of a complete en-bloc technique with direct bladder neck incision: A newly modified approach for holmium laser enucleation of the prostate. J Endourol 33:835\\u0026ndash;840. https://doi.org/10.1089/end.2018.0773\\u003c/li\\u003e\\n \\u003cli\\u003eLin SL, Lin CT, Huang WT, Jou YC, Tzai TS, Tsai YS (2019) History of urinary retention is a risk factor for infection after prostate biopsy: A nationwide, population-based cohort study. Surg Infect 20:202\\u0026ndash;207. https://doi.org/10.1089/sur.2018.174\\u003c/li\\u003e\\n \\u003cli\\u003eWu YP, Li XD, Ke ZB, Chen SH, Chen PZ, Wei Y, et al (2018) Risk factors for infectious complications following transrectal ultrasound-guided prostate biopsy. Infect Drug Resist 11:1491\\u0026ndash;1497. https://doi.org/10.2147/IDR.S171162\\u003c/li\\u003e\\n \\u003cli\\u003eAktas BK, Bulut S, Gokkaya CS, Ozden C, Salar R, Aslan Y, et al (2014) Association of prostate volume with voiding impairment and deterioration in quality of life after prostate biopsy. Urology 83:617\\u0026ndash;621. https://doi.org/10.1016/j.urology.2013.11.002\\u003c/li\\u003e\\n \\u003cli\\u003ePorto JG, Blachman-Braun R, Ajami T, Zarli M, Chen R, Furtado T, et al (2023) Incidental prostate cancer after holmium laser enucleation of the prostate: critical analysis of independent risk factors and impact on surgical outcomes. BJUI Compass 5:374\\u0026ndash;381. https://doi.org/10.1002/bco2.306\\u003c/li\\u003e\\n \\u003cli\\u003eBarentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746\\u0026ndash;757. https://doi.org/10.1007/s00330-011-2377-y\\u003c/li\\u003e\\n \\u003cli\\u003eWeinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al (2016) PI-RADS prostate imaging\\u0026mdash;reporting and data system: 2015, version 2. Eur Urol 69:16\\u0026ndash;40. https://doi.org/10.1016/j.eururo.2015.08.052\\u003c/li\\u003e\\n \\u003cli\\u003eOerther B, Nedelcu A, Engel H, Schmucker C, Schwarzer G, Brugger T, et al (2024) Update on PI-RADS version 2.1 diagnostic performance benchmarks for prostate MRI: systematic review and meta-analysis. Radiology 312:e233337. https://doi.org/10.1148/radiol.233337\\u003c/li\\u003e\\n \\u003cli\\u003eAgrotis G, Pooch EP, Marsitopoulos K, Vlychou M, Benndorf M, Beets-Tan RGH, Schoots IG (2025) Detection rates for prostate cancer using PI-RADS 2.1 upgrading rules in transition zone lesions align with risk assessment categories: a systematic review and meta-analysis. Eur Radiol 35:6454\\u0026ndash;6465. https://doi.org/10.1007/s00330-025-11618-w\\u003c/li\\u003e\\n \\u003cli\\u003eWenzel M, Welte MN, Grossmann L, Preisser F, Theissen LH, Humke C, et al (2021) Multiparametric MRI may help to identify patients with prostate cancer in a contemporary cohort of patients with clinical bladder outlet obstruction scheduled for holmium laser enucleation of the prostate (HoLEP). Front Surg 8:633196. https://doi.org/10.3389/fsurg.2021.633196\\u003c/li\\u003e\\n \\u003cli\\u003eTsai K, Xu P, Guo J, Dean N, Khondakar N, Michael J, et al (2024) Do Prostate Imaging-Reporting and Data System (PIRADS) lesions predict holmium laser enucleation of prostate outcomes? Prostate 84:1344\\u0026ndash;1351. https://doi.org/10.1002/pros.24771\\u003c/li\\u003e\\n \\u003cli\\u003eLi Y, Wang S, Wang J, Qi X, Liu T, He X, et al (2025) PI-RADSv2.1 combined with PSA density for optimizing prostate biopsy decisions: a retrospective analysis. Front Oncol 15:1602412. https://doi.org/10.3389/fonc.2025.1602412\\u003c/li\\u003e\\n \\u003cli\\u003eZheng S, Jiang S, Chen Z, Huang Z, Shi W, Liu B, et al (2019) The roles of MRI-based prostate volume and associated zone-adjusted prostate-specific antigen concentrations in predicting prostate cancer and high-risk prostate cancer. PLOS One 14:e0218645. https://doi.org/10.1371/journal.pone.0218645\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" style=\\\"width: 863px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable 1. Preoperative characteristic of patients with and without incidental prostate cancer following HoLEP\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e \\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOverall (n =114)\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBPH (n=97)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIPCa (n=17)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eAge, years (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e75 (56-98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e75 (56-98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e76 (62-85)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003ePSA, ng/ml (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e5.4 (0.2-28.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e5.2 (0.2-28.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e7.2 (1.4-20.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eTPV, ml (Median, range) \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e73 (15-230)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e73 (15-230)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e80 (34-160)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eTZV, ml (Median, range)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e50 (7-200)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e50 (13-200)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e50 (20-100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"30\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003ePSAD-TZ, ng/ml/mll (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e0.11 (0.012-0.65)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e0.11 (0.012-0.65)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e0.19 (0.04-0.47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"30\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eIPSS (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e14 (1-35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e14 (1-35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e15 (0-34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eQoL score (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e4 (1-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e4 (1-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e5 (3-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eQmax, ml/sec\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e7.5 (2.6-19.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e7.0 (2.6-16.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e8.6 (3.5-19.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003ePVR, ml (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e91 (0-750)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e104 (0-750)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e67 (12-158)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eDutasteride, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e32 (28.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e27 (28.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e5 (29.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e82 (71.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e69 (71.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e12 (70.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003ePrevious prostate biopsy, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e24 (21.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e20 (20.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e4 (23.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e90 (78.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e77 (79.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e13 (76.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 272px;\\\"\\u003e\\n \\u003cp\\u003eMRI findings in TZ, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eNegative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e87 (76.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e81 (83.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e6 (35.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003ePIRADS 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e15 (13.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e10 (10.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e5 (29.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003ePIRADS 4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e12 (10.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e6 (6.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 138px;\\\"\\u003e\\n \\u003cp\\u003e6 (35.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 863px;\\\"\\u003e\\n \\u003cp\\u003eHoLEP = holmium laser enucleation of the prostate; PSA= prostate-specific antigen; TPV=total prostate volume; TZV=transition zone volume; TZ= transition zone; PSAD-TZ=PSA density of TZ; IPSS = International Prostate Symptom Score; QoL = quality of life; Qmax = maximum flow rate; PVR = postvoid residual; MRI=magnetic resonance imaging; BPH=benign prostatic hyperplasia; iPCa=incidental prostate cancer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" style=\\\"width: 52.9025%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable 2. Preoperative characteristic of patients with and without MRI-TZ findings\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e \\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOverall\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n =114)\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMRI-TZ: Negative (n=87)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMRI-TZ: Positive (n=27)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003eAge, years (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e75 (56-98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e75 (56-98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e75 (60-87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003ePSA, ng/ml (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e5.4 (0.2-28.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e5.1 (0.2-28.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e7.9 (2.0-24.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003eTPV, ml (Median, range)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e73 (15-230)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e70 (20-230)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e79 (15-112)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003eTZV, ml (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e50 (7-200)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e50 (7-200)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e50 (20-90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"30\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003ePSAD-TZ, ng/ml/mll (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e0.11 (0.002-0.65)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e0.11 (0.002-0.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e0.15 (0.04-0.65)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.031\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"30\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003eIPSS (Median, range)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e14 (1-35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e13 (1-34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e18 (6-35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003eQoL score (Median, range)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e4 (1-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e4 (1-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e4 (2-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003eQmax, ml/sec\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e7.5 (2.6-19.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e7.3 (2.6-16.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e8.1 (3.5-19.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003ePVR, ml (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e91 (0-750)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e100 (0-600)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e67 (12-750)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003eDutasteride, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e32 (28.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e26 (29.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e6 (22.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e82 (71.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e61 (70.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e21 (77.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 16.7545%;\\\"\\u003e\\n \\u003cp\\u003ePrevious prostate biopsy, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e24 (21.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e12 (13.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e12 (44.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 4.296%;\\\"\\u003e\\n \\u003cp\\u003e0.0007\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 4.0505%;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8.7148%;\\\"\\u003e\\n \\u003cp\\u003e90 (78.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e75 (86.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9.574%;\\\"\\u003e\\n \\u003cp\\u003e15 (55.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 52.9025%;\\\"\\u003e\\n \\u003cp\\u003eMRI=magnetic resonance imaging; TZ= transition zone; PSA= prostate-specific antigen; TPV=total prostate volume; TZV=transition zone volume; IPSS = International Prostate Symptom Score; QoL = quality of life; Qmax = maximum flow rate; PVR = postvoid residual\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0.3682%;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable 3. Preoperative surgical and clinical outcomes 3months after HoLEP\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOverall (n =114)\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBPH (n=97)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIPCa (n=17)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003eEnucleation time, min (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e39 (18-110)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e39 (18-110)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e39 (18-82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003eEnucleation weight, g (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e41 (4-117)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e40 (4-117)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e36 (12-90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative PSA, ng/ml/ml (Median, range)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e0.41 (0.03-3.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e0.37 (0.03-3.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e0.48 (0.04-3.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003ePSA reduction rate (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e92.3 (-14.9-99.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e92.3 (-14.9-98.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e91.2 (60.9-99.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003eIPSS (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e7 (1-26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e7 (1-26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e7 (1-23)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003eQoL score (Median, range)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e2 (0-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e2 (0-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e3 (0-6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003eQmax, ml/sec\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e16.7 (2.6-49.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e17.8 (2.6-49.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e15.1 (4.6-31.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 340px;\\\"\\u003e\\n \\u003cp\\u003ePVR, ml (Median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e38 (0-234)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e33 (0-234)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 154px;\\\"\\u003e\\n \\u003cp\\u003e22 (0-60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"5\\\" style=\\\"width: 877px;\\\"\\u003e\\n \\u003cp\\u003eHoLEP = holmium laser enucleation of the prostate; PSA= prostate-specific antigen; IPSS = International Prostate Symptom Score; QoL = quality of life; Qmax = maximum flow rate; PVR = postvoid residual; BPH=benign prostatic hyperplasia; iPCa=incidental prostate cancer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4. Logistic regression assessing clinical factors associated with incidental prostate cancer diagnosis after HoLEP\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\" class=\\\"fr-table-selection-hover\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e \\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 31px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eUnivariate analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 31px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMultivariate analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e \\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOdds\\u0026nbsp;ratio\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95%\\u0026nbsp;CI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOdds\\u0026nbsp;ratio\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95%\\u0026nbsp;CI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eAge \\u0026gt;75, years (yes vs. no)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e2.40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e0.86 to 7.39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003ePSA \\u0026gt;6.2, ng/ml (yes vs. no)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e3.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e1.10 to 10.29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.026\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e1.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e0.24 to 4.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003ePSAD-TZ \\u0026gt; 0.18, ng/ml/ml \\u0026nbsp;(yes vs. no)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e3.19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e1.11 to 9.20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.033\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e2.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e0.68 to 12.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eDutasteride (yes vs. no)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e1.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e0.34 to 3.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003ePrevious prostate biopsy (yes vs. no)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e1.18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e0.35 to 4.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eMRI findings in TZ (yes vs. no)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e9.28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e2.99 to 28.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.0001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 2px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 11px;\\\"\\u003e\\n \\u003cp\\u003e8.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 12px;\\\"\\u003e\\n \\u003cp\\u003e2.68 to 29.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e0.0004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"8\\\" rowspan=\\\"2\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003eHoLEP = holmium laser enucleation of the prostate; PSA= prostate-specific antigen; TZ=transition zone; PSAD-TZ=PSA density of TZ; MRI=magnetic resonance imaging\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd height=\\\"36\\\" style=\\\"width: 0px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"benign prostatic hyperplasia, holmium laser enucleation, incidental prostate cancer, Prostate Imaging-Reporting and Data System (PI-RADS)\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9039945/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9039945/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground: \\u003c/strong\\u003eTo assess the effectiveness of magnetic resonance imaging (MRI) of the transition zone (TZ) for predicting incidental prostate cancer (iPCa) detected after holmium laser enucleation of the prostate (HoLEP) by comparing cases with and without iPCa.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eWe retrospectively evaluated 136 patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between June 2022 and April 2025. After excluding seven patients with biopsy-confirmed prostate cancer, data from 114 patients were analyzed and divided into two groups: iPCa (n = 17) and BPH (n = 97). The preoperative and postoperative outcomes were compared. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of iPCa. MRI assessment focused exclusively on the TZ according to the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eMRI-TZ findings (PI-RADS score of 3 or more) were significantly more prevalent in the iPCa group than in the BPH group (64.7% vs. 16.5%, p \\u0026lt; 0.0001). Univariate analysis identified both MRI-TZ findings and prostate-specific antigen (PSA) levels greater than 6.2 ng/mL and TZ-adjusted PSA levels (PSAD-TZ) greater than 0.18 ng/mL/mL as significant predictors of iPCa. However, multivariate logistic regression identified only MRI-TZ findings as an independent predictor of iPCa (odds ratio, 8.96; 95% confidence interval: 2.68–29.9; p = 0.0004). No significant differences in postoperative urinary outcomes were observed between the two groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion: \\u003c/strong\\u003ePreoperative MRI-TZ findings may predict iPCa in patients undergoing HoLEP and potentially guide individualized perioperative risk stratification.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Preoperative magnetic resonance imaging findings in the transition zone predict incidental prostate cancer in holmium laser enucleation of the prostate\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-10 16:22:02\",\"doi\":\"10.21203/rs.3.rs-9039945/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"2c32f807-f1d6-498d-b09c-a9189d2d5db2\",\"owner\":[],\"postedDate\":\"March 10th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-06T09:11:44+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-10 16:22:02\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9039945\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9039945\",\"identity\":\"rs-9039945\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}