Category: BPH/LUTS: Outcomes & Complications
Introduction & Objective : There is limited data evaluating oncologic outcomes in patients on active surveillance (AS) for prostate cancer (PCa) who subsequently underwent Holmium Laser Enucleation the Prostate (HoLEP). We present functional and oncologic outcomes for PCa patients undergoing HoLEP for refractory LUTS.
We queried patients with an existing prostate cancer diagnosis that elected active surveillance and ultimately developed significant lower urinary tract symptoms managed with HoLEP between 2007 and 2017. After excluding patients with planned definitive prostate cancer therapy prior to HoLEP, we were left with 25 patients. We utilized descriptive statistics, univariable cox regression, and Kaplan Meier analysis.
Median time on AS prior to HoLEP was 1.5 years. Median post-HoLEP follow-up was 27.5 months. 88% were diagnosed with grade group (GG) 1 PCa and were stage cT1c. Mean pre-HoLEP PSA was 8.4 ng/ml. 24% of men were upgraded to a higher GG on HoLEP pathology. 83% of upgraded patients had definitive therapy vs. 10.5% of non-upgraded patients. Upgrading at HoLEP was the only predictor of eventual prostate cancer treatment on univariable cox regression (HR 10.9,p=0.01). 67% of patients remained on AS 20 months from HoLEP. A 74% decrease in AUA symptom score was noted with a low rate of any pad usage (8.0%) at initial 3 month follow-up.
AS patients undergoing HoLEP had significant improvement in LUTS with little risk of significant incontinence at initial follow up. Two-thirds of patients remained on AS, and only GG upgrading at the time of HoLEP predicted need for additional PCa treatment.
Derek Gearman– Resident Physician, Mayo Clinic - Rochester, Rochester, Minnesota
Deepak Agarwal– Resident Physician, Mayo Clinic (Rochester), Rochester, Minnesota
Vidit Sharma– Mayo Clinic (Rochester), Rochester, Minnesota
Marcelino Rivera– Assistant Professor, Mayo Clinic (Rochester), Rochester, Minnesota