Presentation Authors: Charles Nottingham*, Tim Large, Julia Fiuk, James Lingeman, Indianapolis, IN
Introduction: Patients with prostate cancer (PC) who wish to pursue active surveillance (AS) present a unique challenge to the urologist if these men have lower urinary tract symptoms (LUTS) or urinary retention. The objective of this study was to describe clinical and pathologic outcomes for patients on AS for PC who also underwent holmium laser enucleation of the prostate (HoLEP) for LUTS or urinary retention.
Methods: Through an IRB-approved protocol, we prospectively collect preoperative, perioperative, and postoperative data on all patients undergoing HoLEP at our institution. We queried this database to include all men with a known diagnosis of PC who chose active surveillance as primary treatment for their malignancy. We excluded men who were planning to undergo radiation as primary cancer treatment following debulking HoLEP due to obstructive LUTS. Perioperative and postoperative patient characteristics were evaluated.
Results: We included 71 patients for analysis (Table 1). The median patient age was 74 years, and 38% of patients required an indwelling catheter or intermittent catheterization for urinary retention before surgery. Preoperatively, the majority of patients had Gleason sum 6 PC and the median PSA for the group was 9.0 ng/mL (IQR 5.9-13.6). The median weight of tissue removed was 73 grams (IQR 37-101). Most patients (63.4%) had no malignancy on HoLEP pathology, and the three patients with preoperative Gleason 7 and 8 had either Gleason 6 or no cancer on HoLEP pathology. Over a median 12-month follow-up period, all patients were free of urinary retention, and 90.1% of patients remained on AS without plans for other therapy. Median AUA symptom scores were significantly lower postoperatively compared to preoperatively (6 vs 22, respectively; p < 0.01). Additionally, the PSA decreased to a median of 1.4 ng/mL (IQR 0.7-3.5).
Conclusions: In patients with LUTS or urinary retention wishing to undergo AS for PC, HoLEP will provide many men significant symptomatic improvement and relief of urinary retention while allowing them to continue this treatment option.