Advertisement

HoLEP in Patients with Low Risk Prostate Cancer is Safe and Effective

Login to Access Video or Poster Abstract: MP02-08
Sources of Funding: None

Introduction

When a man with surveillance-appropriate low risk prostate cancer (PCa) has significantly bothersome BPH in a large gland, this typically tips the scales towards either radical prostatectomy or radiation therapy. However this presumes the PCa is the more threatening of his coexisting conditions. Incidentally discovered (T1a/b) PCa following Holmium Laser Enucleation of the Prostate (HoLEP) is a well known phenomenon. However, performing HoLEP in the setting of a PCa harboring gland has been underexplored. Herein, we describe outcomes of HoLEP in a select cohort of patients with significant LUTS, and known low risk PCa._x000D_

Methods

Data were collected retrospectively on patients undergoing HoLEP by a single surgeon. A select group of well informed patients with large symptomatic glands and low risk cancer were carefully counseled that HoLEP was an option to address the obstructive BPH, would unpredictably remove the cancer (all, part, or none), emphasizing they were not undergoing a cancer operation, and that HoLEP would be followed by continued surveillance. Pre- and post-operative clinical factors, and operative and hospital stay data were collected.

Results

In total, 7 men were included. All men had Gleason 3+3 cancer in at most 20% of at most 3 cores on biopsy. Other preop characteristics are described in Table 1. Mean tissue removed was 48.8g. No patients required transfusion or reoperation. Median length of hospital stay was 24.5 hours; median length of catheterization was 19 hours. On final pathology, 3 of 7 of patients had cancer in the specimen, all of which were Gleason 3+3. At f/u, all flow rates improved, PVR improved or remained low, and PSA significantly decreased in all patients (Table 1). No patient have developed stricture, bladder neck contracture, incontinence, or required reoperation. Median f/u time was 4 months (range 4-24 months). Notably, 2 patients had prostate MRI within 2 years of HoLEP, neither of which showed suspicion for PCa.

Conclusions

We have offered HoLEP judiciously to select patients on surveillance for low risk PCa and significant symptomatic BPH, a complex and increasingly common scenario, with acceptable short term outcomes. Further investigations into long-term cancer-specific outcomes, as well as strategies for continued surveillance, will be crucial in order to further evaluate and refine this new approach.

Funding

None

Authors
Kristian Stensland
Daniel Pelzman
Christopher Robertson
Jared Schober
Alireza Moinzadeh
David Canes
Jessica Mandeville
back to top