Presented by: michael Frumer MD
Rabin Medical Center

Introduction

The surgical treatment of men with enlarged symptomatic prostate and concurrent prostate cancer (PCa) is not well defined. This study aims to compare the surgical complications and success rate in men undergoing holmium laser enucleation of the prostate (HoLEP) with and without prostate cancer.

Materials

The medical records of patients treated with HoLEP between 2016 to 2023 at a single institution were assessed retrospectively. The study group included patients who already had PCa diagnosis or incidentally detected PCa at HoLEP. The control group included patients without pre-existing PCa and with benign surgical pathology. Peri- and postoperative variables were compared between the groups using Pearson's chi-squared test for categorical variables and Mann–Whitney test for continuous variables.

Results

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Included were 704 men with a median age of 71.5 years (IQR 66, 77) and a median prostate size of 102 cc (IQR 85, 130). The study group included 37 (5%) patients: 16 patients with pre-existing PCa and another 21 with incidentally detected PCa. Overall, 28 (76%) patients had ISUP grade 1, and 9 (24%) patients had grades ≥ 2. The control group included 667 (95%) patients without PCa. The surgical time and the resected prostate tissue volume were similar. No significant difference was found between the groups when comparing peri- and postoperative complications and surgical outcomes (Table 1). At a median follow-up of 18.3 months (IQR 16, 27), all patients who underwent cancer treatment post-HoLEP survived without cancer progression.

Conclusion

Patients with PCa can safely undergo HoLEP with a notably high catheter-free rate. Postoperative monitoring and treatment are feasible and can detect disease progression requiring definitive treatment. Further research is needed to optimize surveillance strategies and long-term cancer-specific outcomes.

Funding

None

Co-Authors

Abd Elhalim Darawsha, MD
Rabin Medical Center

Gherman Creiderman, MD
Rabin Medical Center

Ron Gilad, MD
Rabin Medical Center

Tzach Aviv, MD
Rabin Medical Center

Sagi Arieh Shpitzer, MD
Rabin Medical Center

Muhammad Krenawi, MD
Rabin Medical Center

Tomer Weizman, MD
Rabin Medical Center

Shayel Bercovich, MD
Rabin Medical Center

Nadav Dekel, MD
Rabin Medical Center

Hadar Tamir, MD
Rabin Medical Center

Tal Wax, MD
Rabin Medical Center

Tomer Hasdai, MD
Rabin Medical Center

Yossi Ventura, MD
Rabin Medical Center

Niv Segal, MD
Rabin Medical Center

Hen Hendel, MD
Rabin Medical Center

Liran Zieber, MD
Rabin Medical Center

Dmitry Enikeev, MD
Rabin Medical Center

Yaron Ehrlich, MD
Rabin Medical Center