Holmium laser enucleation of the prostate in men on active surveillance for prostate cancer with refractory lower urinary tract symptoms secondary to enlarged prostates.
HoLEP
active surveillance
lower urinary tract symptoms
prostate cancer
Journal
The Prostate
ISSN: 1097-0045
Titre abrégé: Prostate
Pays: United States
ID NLM: 8101368
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
01
07
2022
received:
12
04
2022
accepted:
05
08
2022
pubmed:
6
9
2022
medline:
15
12
2022
entrez:
5
9
2022
Statut:
ppublish
Résumé
The surgical treatment of men with lower urinary tract symptoms (LUTS) and significantly enlarged symptomatic prostates on active surveillance (AS) for low-risk prostate cancer (PCa) is not well defined. We report our single-institution initial experience with holmium laser enucleation of the prostate (HoLEP) for LUTS in men with low-risk PCa being managed with AS. Men on AS who underwent HoLEP between 2013 and 2019 were identified. Data regarding preoperative cancer workup, prostate-specific antigen (PSA), perioperative outcomes, and voiding parameters were analyzed. Postoperative surveillance for PCa including PSA nadir, prostate magnetic resonance imaging, prostate biopsy (PBx), and PSA at last follow-up were evaluated. Twenty men met the inclusion criteria. Preoperative mean max flow 7.9 ml/s, median postvoid residual 101 cc, and mean transrectal ultrasound prostate size 99 cc. Patients had a median adjusted preoperative PSA of 8.5 (interquartile range [IQR]: 4.8-13.2) ng/ml. Mean resected tissue weight was 65.5 g with improved postoperative flow rate and significantly decreased residual. A total of 5/20 men had PCa in the specimen (all Gleason Grade Group 1). The median postoperative PSA nadir was 1.2 (IQR: 0.5-1.8) ng/ml at median of 5 months. At the last follow-up (median 18.5 months, IQR: 10.5-37.8), the median postoperative PSA was 1.4 (IQR: 0.63-2.48) ng/ml. Nine men underwent postoperative multiparametric magnetic resonance imaging (mpMRI) with the identification of a new prostate imaging reporting and data system 5 lesion in one patient who underwent negative fusion biopsy. Five men underwent post-HoLEP PBx with progression in two patients, who both successfully underwent radical prostatectomy. Men on AS for low-risk PCa can safely undergo HoLEP with significantly improved voiding parameters. Postoperative monitoring with PSA, mpMRI, and PBx can detect disease progression requiring definitive treatment. Further research is needed to optimize surveillance strategies and long-term cancer-specific outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
39-43Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Cooperberg MR, Carroll PR, Klotz L. Active surveillance for prostate cancer: progress and promise. J Clin Oncol. 2011;29(27):3669-3676.
Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol. 2015;33(30):3379-3385.
Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33(3):272-277.
Toren P, Wong LM, Timilshina N, et al. Active surveillance in patients with a PSA >10 ng/ml. Can Urol Assoc J. 2014;8(9-10):702-706.
Sivarajan G, Borofsky MS, Shah O, Lingeman JE, Lepor H. The role of minimally invasive surgical techniques in the management of large-gland benign prostatic hypertrophy. Rev Urol. 2015;17(3):140-149.
Bhojani N, Boris RS, Monn MF, Mandeville JA, Lingeman JE. Coexisting prostate cancer found at the time of holmium laser enucleation of the prostate for benign prostatic hyperplasia: predicting its presence and grade in analyzed tissue. J Endourol. 2015;29(1):41-46.
Rivera ME, Frank I, Viers BR, Rangel LJ, Krambeck AE. Holmium laser enucleation of the prostate and perioperative diagnosis of prostate cancer: an outcomes analysis. J Endourol. 2014;28(6):699-703.
Elkoushy MA, Elshal AM, Elhilali MM. Incidental prostate cancer diagnosis during holmium laser enucleation: Assessment of predictors, survival, and disease progression. Urology, 2015;86(3):552-557.
Elmansy HM, Elzayat EA, Sampalis JS, Elhilali MM. Prostatic-specific antigen velocity after holmium laser enucleation of the prostate: possible predictor for the assessment of treatment effect durability for benign prostatic hyperplasia and detection of malignancy. Urology. 2009;74(5):1105-1110.
Abedi AR, Ghiasy S, Fallah-Karkan M, Rahavian A, Allameh F. The management of patients diagnosed with incidental prostate cancer: narrative review. Res Rep Urol. 2020;12:105-109.
Helfand BT, Mongiu AK, Kan D, et al. Outcomes of radical prostatectomy for patients with clinical stage T1a and T1b disease. BJU Int. 2009;104(3):304-309.
Capitanio U. Contemporary management of patients with T1a and T1b prostate cancer. Curr Opin Urol. 2011;21:252-256.
Dusing MW, Krambeck AE, Terry C, et al. Holmium laser enucleation of the prostate: efficiency gained by experience and operative technique. J Urol. 2010;184:635-640.
Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS prostate imaging-reporting and data system: 2015, version 2. Eur Urol. 2016;69(1):16-40.
Oesterling JE, Jacobsen SJ, Chute CG, et al. Serum prostate-specific antigen in a community-based population of healthy men. JAMA. 1993;270(7):860-864.
Djavan B, Zlotta AR, Byttebier G, et al. Prostate specific antigen density of the transition zone for early detection of prostate cancer. J Urol. 1998;160:411-419.
Tinmouth WW, Habib E, Kim SC, et al. Change in serum prostate specific antigen concentration after holmium laser enucleation of the prostate: a marker for completeness of adenoma resection? J Endourol. 2005;19:550-554.
Gellhaus PT, Monn MF, Leese J, et al. Robot-assisted radical prostatectomy in patients with a history of holmium laser enucleation of the prostate: feasibility and evaluation of initial outcomes. J Endourol. 2015;29(7):764-769.