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Risk factors for incidental prostate cancer following surgery for benign prostatic enlargement: A systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases (2026)Cite this article

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Abstract

Background

Incidental prostate cancer (IPC) is not uncommon in patients undergoing surgery for benign prostate enlargement (BPE). However, the associated risk factors remain incompletely understood. This study aimed to evaluate potential clinical predictors of IPC.

Methods

A systematic search of MEDLINE, Embase, and Web of Science was conducted in January 2025 to identify studies assessing risk factors for IPC. Pairwise meta-analyses were performed using a random-effects model, pooling adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable analyses. Risk of bias was evaluated using the ROBINS-I tool. (PROSPERO: CRD42024588776).

Results

Twenty-five studies comprising 247,966 patients were included. IPC was identified in 6,748 patients, with reported rates ranging from 2.2% to 49.6%. Significant risk factors for IPC included: Elevated PSA level (OR: 1.03; 95% CI: 1.01–1.05; p = 0.01), PSA density >0.15 ng/mL/cc (OR: 3.02; 95% CI: 1.50–6.07; p = 0.01), Older age (OR: 1.05; 95% CI: 1.01–1.08; p = 0.01), and Higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02–1.18; p = 0.01). Prostate volume, diabetes, and dyslipidemia were not associated with IPC risk. Notably, use of 5-alpha reductase inhibitors (5-ARIs) was linked to a significantly reduced risk (OR: 0.53; 95% CI: 0.33–0.85; p = 0.01). Study limitations included heterogeneity across studies, retrospective designs, and incomplete reporting of key variables.

Conclusions

Elevated PSA, high PSA density, older age, and increased BMI were associated with a higher risk of IPC in patients undergoing surgery for BPE. Conversely, preoperative use of 5-ARIs was associated with a reduced risk. These findings may support improved preoperative risk stratification and help identify patients in whom additional diagnostic evaluations could be considered or avoided. Further research is needed to better define predictors of clinically significant IPC.

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Acknowledgements

Marcin Miszczyk was supported by the European Urological Scholarship Programme (EUSP) Scholarship of the European Association of Urology (EAU).

Author information

Author notes

  1. These authors contributed equally: Angelo Cormio, Akihiro Matsukawa.

Authors and Affiliations

  1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Angelo Cormio, Akihiro Matsukawa, Alessandro Dematteis, Ahmed R. Alfarhan, Marcin Miszczyk, Navid Roessler, Abdulrahman S. Alqahtani, Stefano Mancon, Ichiro Tsuboi, Paweł Rajwa, David D’Andrea & Shahrokh F. Shariat

  2. Division of Anatomy, Medical University of Vienna, Vienna, Austria

    Angelo Cormio, Akihiro Matsukawa, Alessandro Dematteis, Ahmed R. Alfarhan, Marcin Miszczyk, Navid Roessler & Abdulrahman S. Alqahtani

  3. Department of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy

    Angelo Cormio & Andrea Benedetto Galosi

  4. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Akihiro Matsukawa & Takahiro Kimura

  5. Department of Surgical Sciences, Division of Urology, AOU Città della Salute e della Scienza at Molinette Hospital and University of Turin, Turin, Italy

    Alessandro Dematteis

  6. Department of Urology, Prince Saud Bin Jalawi Hospital, Al Ahsa Health Cluster, Al Ahsa, KSA, Saudi Arabia

    Ahmed R. Alfarhan

  7. Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland

    Marcin Miszczyk

  8. Department of Urology, Medical University Center Hamburg-Eppendorf, Hamburg, Germany

    Navid Roessler

  9. Department of Urology, Ministry of Health Saudi Arabia, Second Health cluster, Riyadh, KSA, Saudi Arabia

    Abdulrahman S. Alqahtani

  10. Department of Biomedical Sciences, Humanitas University, Pieve Milan, Italy

    Stefano Mancon

  11. Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy

    Stefano Mancon

  12. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan

    Ichiro Tsuboi

  13. Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland

    Paweł Rajwa

  14. Division of Surgery and Interventional Science, University College London, London, UK

    Paweł Rajwa

  15. Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, Foggia, Italy

    Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri & Luigi Cormio

  16. Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, Stockholm, Sweden

    Ugo Giovanni Falagario

  17. Pathology Unit, Policlinico Foggia, University of Foggia, Foggia, Italy

    Francesca Sanguedolce

  18. Department of Urology, Bonomo Teaching Hospital, Andria, Italy

    Luigi Cormio

  19. Department of Urology, the University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shahrokh F. Shariat

  20. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  21. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia

    Shahrokh F. Shariat

  22. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan

    Shahrokh F. Shariat

  23. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  24. Research Center for Evidence Medicine, Urology Department Tabriz University of Medical Sciences, Tabriz, Iran

    Shahrokh F. Shariat

Authors
  1. Angelo Cormio
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  2. Akihiro Matsukawa
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  3. Alessandro Dematteis
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  4. Ahmed R. Alfarhan
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  5. Marcin Miszczyk
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  6. Navid Roessler
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  7. Abdulrahman S. Alqahtani
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  12. Francesca Sanguedolce
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  14. Carlo Bettocchi
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  15. Giuseppe Carrieri
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  16. Luigi Cormio
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  18. David D’Andrea
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  19. Takahiro Kimura
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Contributions

AC and AM contributed to protocol/project development, data collection and management, data analysis, creating Tables, and manuscript writing/editing. AD, ARA, MM, NR, ASA, SM, IT contributed to manuscript writing/editing. PR, UGF, FS contributed to manuscript editing. GMB, CB, GC, LC, ABG, DD, TK, SFS contributed to supervision and manuscript editing.

Corresponding author

Correspondence to Angelo Cormio.

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Competing interests

Shahrokh F. Shariat received the following: Honoraria: Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Roche, Takeda Consulting or Advisory Role: Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Takeda Speakers Bureau: Astellas, Astra Zeneca, Bayer, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Richard Wolf, Roche, Takeda. Pawel Rajwa is a paid consultant/advisor of Janssen. The other authors declare no conflicts of interest associated with this manuscript.

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Cormio, A., Matsukawa, A., Dematteis, A. et al. Risk factors for incidental prostate cancer following surgery for benign prostatic enlargement: A systematic review and meta-analysis. Prostate Cancer Prostatic Dis (2026). https://doi.org/10.1038/s41391-026-01108-5

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