Holmium Laser Enucleation of Prostate (HoLEP) in Patients with Pre-existing Localized Prostate Cancer, Dual Center Study - Beyond the Abstract

With a growing role for active surveillance for low-risk prostate cancer, a significant proportion of patients on active surveillance can suffer lower urinary tract symptoms (LUTS) due to associated large benign prostate adenoma.

Moreover, radiotherapy for localized prostate cancer is usually associated with a surge in LUTS, especially in patients with large prostate or significant pre-existing LUTS symptom scores. We aimed to study the role of Holmium laser enucleation of the prostate (HoLEP) in prostate cancer patients with bothersome lower urinary tract symptoms (LUTS) either with ongoing active surveillance or planning for prostate debulking before radiotherapy through the experience of two institutions with a large experience with HoLEP.

Regarding functional outcomes, HoLEP was very safe and effective in debulking the prostate with significant improvement of IPSS scores and QOL post-HoLEP. From an oncological perspective, median serum PSA has significantly dropped from baseline 7.6 (5.3- 14.9) before HoLEP to 1.3 (0.6-3.1), 1.4 (0.75-2.9), 1.7 (0.86-2.75) at 6-week, 3-month, 1-year follow up encounters (P< 0.001). PSA drop post-HoLEP indicates that HoLEP helps eliminate the contribution of large volume adenoma to PSA level thus giving a better reflection of the serum PSA level in those patients. Accordingly, a considerable percentage of those patients especially those with marked PSA level drop post-HoLEP were able to continue with active surveillance without PSA anxiety or the need for over-biopsy or radiotherapy.

Written by: Mohamed Elsaqa, MD & Marawan M. El Tayeb, MD, Baylor Scott & White Medical Center, Temple, Texas

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