# Incidental prostate cancer status in two tertiary centers in Kigali, Rwanda: insights from a retrospective review

## TL;DR

This study finds a 4% incidental prostate cancer rate in BPH surgical specimens in Rwanda, with some cases being high-grade and requiring careful preoperative evaluation.

## Contribution

The first reported data on incidental prostate cancer rates in Rwanda, highlighting clinical implications for preoperative assessment.

## Key findings

- Incidental prostate cancer was diagnosed in 4% of BPH surgical specimens.
- Symptoms like hematuria and low back pain were strongly associated with incidental cancer diagnosis.
- One case was upstaged to T3b postoperatively, indicating potential for more aggressive disease.

## Abstract

prostate cancer is reported in 16.7% of benign prostate hyperplasia (BPH) surgical specimens. This incidental prostate cancer (IPCa) is usually low grade. While incidence rates vary widely across regions, no published data exist from Rwanda, thus motivating this study.

this was a retrospective cross-sectional analysis of Trans-Urethral Resection of Prostate (TURP) and open simple prostatectomy specimens from two tertiary hospitals between January 2015 and October 2022 to identify IPCa rate. The clinical characteristics and pathology reports were retrieved. Independent t-test, Fisher´s exact test, and logistic regression were performed to assess associations between clinical characteristics and occurrence of IPCa.

we included 153 patients, mean age 70 years (SD: ±10). 140/153 patients had Lower Urinary Tract Symptoms (LUTS), macrohematuria 4/153, and low back pain 1/153. IPCa was diagnosed in six individuals (6/153, 4%). One patient (1/6) with hematuria and the sole patient with low back pain had IPCa diagnosis (respectively OR: 16.4, 95% CI: 1.1 - 235.9, P=0.04 and OR 38.8, 95% CI: 1.5 - 881.2, P=0.02). Age, prostate volume, and a PSA >4ng/mL were not predictors of IPCa. Grade group (GG) 2 had 2/6 patients, while GG 1, 3, 4, and 5 had 1/6 each. Clinically, 1/6 were cT1a, 5/6 cT1b, with one patient upstaged to T3b postoperatively. Cancer management was watchful waiting in 2/6, active surveillance in 1/6, and androgen deprivation therapy in 3/6 patients.

the incidence of prostate cancer in BPH specimens may be low but occasionally high-grade. Patients with symptoms beyond LUTS need careful assessment preoperatively. Larger prospective studies are needed to corroborate these findings for clinical use.