Objectives: To assess outcomes of patients diagnosed with prostate cancer (PCa) undergoing holmium laser enucleation of the prostate (HoLEP).
Methods: From 2009-2012, 450 patients underwent HoLEP at our institution. Retrospective review of these patients to identify those with PCa was performed.
Results: PCa was diagnosed in 57 (12.7%) HoLEP patients: 11 (19.2%) preoperatively, 43 (75.4%) in the operative specimen and 3 (5.4%) during follow-up. Mean time to PCa development in the postoperative group was 16 months (9-23). There was no difference in patient characteristics for those diagnosed with PCa at time of HoLEP or in the postoperative period. There were 5 patients with GS > 8 and 52 with GS < 8 PCa. In the operative group, 39 (91%) elected for active surveillance and 4 (9%) elected cancer treatment. In sub-group analysis, men diagnosed with GS >8 intra or postoperative, had significantly elevated preoperative, postoperative and percent change PSA when compared to patients diagnosed GS ≤ 7, p= 0.01, 0.02 and 0.01 respectively. There were no complications, all are voiding spontaneously and 1 patient has persistent incontinence.
Conclusion: HoLEP for the treatment of lower urinary tract symptoms in selectively chosen men with known PCa can safely improve urination. Furthermore, PCa is diagnosed at the time of or post HoLEP in nearly 12% of patients. Those patients with persistently elevated post HoLEP PSA or low percent change PSA should raise suspicion for high GS PCa. Finally, HoLEP does not preclude active surveillance or treatment for PCa when appropriate.
Written by:
Rivera ME, Frank I, Viers BR, Rangel LJ, Krambeck AE. Are you the author?
Mayo Clinic, Urology, 200 First St SW, Rochester, Minnesota, United States, 55901.
Reference: J Endourol. 2014 Feb 2. Epub ahead of print.
doi: 10.1089/end.2014.0009
PubMed Abstract
PMID: 24484284
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