Presented by: Adam Wiggins MD
Lahey Hospital and Medical Center

Introduction

The safety and feasibility of surgical treatment for BPH and lower urinary tract symptoms in men on active surveillance (AS) for known low-risk prostate cancer (PCa) is not well studied. We previously reported 20 patients with low risk PCa on AS who underwent holmium laser enucleation of the prostate (HoLEP). Herein, we provide an updated and expanded cohort analysis, to assess the safety and feasibility of HoLEP in this population.   

Materials

Men on AS who underwent HoLEP between 2013 and 2023 were identified. Data was collected and analyzed, with a focus on oncologic and functional outcomes.  

Results

,

Thirty-nine patients were included in this expanded cohort analysis. The average patient age was 66 years (std dev = 5.4 years), with a mean Body Mass Index of 28 Kg/m² (std dev: 9.2 Kg/m²). The mean pre-operative max flow rate was 8.4 ml/s (std dev = 3.4 ml/sec), with a median postvoid residual of 79cc (interquartile range [IQR]: 57 - 269) and a mean prostate size of 101cc (std dev = 32cc). Patients had a median adjusted preoperative PSA of 9.5 ([IQR]: 4.5-13.5) ng/ml. All men had undergone a prior prostate biopsy, with most men having had one core positive for PCa (median 1; [IQR 1-2]. Concerning post-operative functional data, the mean resected tissue weight was 79g (Std dev = 43) with improved postoperative flow rate (median improvement = 11 ml/s, [IQR] 6 - 21) and decreased post-void residual (median improvement = 85cc, ([IQR] 35 – 245). A total of 10 (26%) men had PCa in the HoLEP specimen (all Gleason Grade Group 1). Regarding oncologic outcomes, the median postoperative PSA nadir was 1ng/ml ([IQR]: 0.5-1.4) at a median of 4 months. At last follow-up (median 17 months, IQR: 4-48), median PSA was 1.8 (IQR: 0.5-1.5) ng/ml. Twelve men underwent postoperative multiparametric magnetic resonance imaging (mpMRI) with the identification of a new Prostate Imaging Reporting and Data System 5 lesion in four patients, who ultimately underwent prostate biopsy. Of these men, three had progression of disease, of which two decided to undergo treatment.  

Conclusion

This updated and expanded analysis of 7 years of follow up data provides further evidence that, while postoperative monitoring with PSA, mpMRI, and biopsy remains necessary to detect disease progression that may require definitive treatment, men on AS for low-risk PCa can safely and feasibly undergo HoLEP with significantly improved voiding parameters.  

Funding

No specific funding. 

Co-Authors

David Canes, MD
Lahey Hospital and Medical Center

Alireza Moinzadeh, MD
Lahey Hospital and Medical Center

Jessica Mandeville, MD
Lahey Hospital and Medical Center