Thulium fiber laser enucleation of the prostate (ThuFLEP) is a minimally invasive treatment for benign prostatic hyperplasia (BPH). Some patients undergoing ThuFLEP are later treated with external beam radiation therapy (EBRT) for incidental or pre-existing prostate cancer. However, the impact of prior ThuFLEP on genitourinary toxicity following EBRT remains unclear.
We conducted a retrospective study including all patients who underwent EBRT following ThuFLEP for prostate cancer in a single center between March 2021 and July 2024. Functional outcomes were assessed using IPSS and IPSS-QoL scores at three time points: pre-surgery, pre-EBRT, and post-EBRT. Incontinence and genitourinary complications were also recorded during the follow-up using the CTCAE scale. Statistical analysis included paired t-tests or Wilcoxon tests for continuous variables and Chi-square tests for categorical variables.
Among 312 patients who underwent ThuFLEP, 13 (4.2%) subsequently received EBRT for prostate cancer. The mean (SD) age of the population was 86.2 years (38.1), and the median (IQR) follow-up was 18.5 (17.4-22.4). Most had a preoperative diagnosis (76.9%) and were treated with either stereotactic body radiotherapy (61.5%) or moderate hypofractionation (38.5%). IPSS significantly improved after ThuFLEP (16.3 ± 6.9 to 10.3 ± 7.4, p = 0.01) and remained stable after EBRT (10.3 ± 7.4 to 8.7 ± 8.2, p = 0.08). Similarly, QoL scores improved post-surgery and were not significantly altered by EBRT. Urinary incontinence was observed in 3 patients after surgery and in 4 after EBRT, including one case of de novo urge incontinence. Acute genitourinary toxicity was low grade (1-2) and mainly frequency (grade 1, n=6, 46.2%) and urgency(grade 1, n=2, 15.4% and grade 2, n=1, 7.7%).
EBRT following ThuFLEP appears feasible and generally well tolerated, with no significant deterioration in urinary symptoms and with low genitourinary toxicity. These findings support the feasibility of combining ThuFLEP and EBRT in selected patients with prostate cancer. Larger prospective studies with extended follow-up are needed to confirm these preliminary results.
The French journal of urology. 2025 Dec 12 [Epub ahead of print]
Gatien Begel, Mickael Andraud, Louis Lenfant, Jérôme Parra, Christophe Vaessen, Aurélien Beaugerie, Quentin Dubourg, Thomas Seisen, Emmanuel Chartier-Kastler, Cyrus Chargari, Morgan Roupret, Ugo Pinar
Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Department of Urology, F-75013 Paris, France., Sorbonne University, APHP, Pitié-Salpêtrière Hospital, Department of Radiotherapy, 75013 Paris, France., Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Department of Urology, F-75013 Paris, France. Electronic address: .