Schober Jared P, Stensland Kristian D, Moinzadeh Alireza, Canes David, Mandeville Jessica
Department of Urology, Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts, USA.
Prostate. 2023 Jan;83(1):39-43. doi: 10.1002/pros.24433. Epub 2022 Sep 5.
The surgical treatment of men with lower urinary tract symptoms (LUTS) and significantly enlarged symptomatic prostates on active surveillance (AS) for low-risk prostate cancer (PCa) is not well defined. We report our single-institution initial experience with holmium laser enucleation of the prostate (HoLEP) for LUTS in men with low-risk PCa being managed with AS.
Men on AS who underwent HoLEP between 2013 and 2019 were identified. Data regarding preoperative cancer workup, prostate-specific antigen (PSA), perioperative outcomes, and voiding parameters were analyzed. Postoperative surveillance for PCa including PSA nadir, prostate magnetic resonance imaging, prostate biopsy (PBx), and PSA at last follow-up were evaluated.
Twenty men met the inclusion criteria. Preoperative mean max flow 7.9 ml/s, median postvoid residual 101 cc, and mean transrectal ultrasound prostate size 99 cc. Patients had a median adjusted preoperative PSA of 8.5 (interquartile range [IQR]: 4.8-13.2) ng/ml. Mean resected tissue weight was 65.5 g with improved postoperative flow rate and significantly decreased residual. A total of 5/20 men had PCa in the specimen (all Gleason Grade Group 1). The median postoperative PSA nadir was 1.2 (IQR: 0.5-1.8) ng/ml at median of 5 months. At the last follow-up (median 18.5 months, IQR: 10.5-37.8), the median postoperative PSA was 1.4 (IQR: 0.63-2.48) ng/ml. Nine men underwent postoperative multiparametric magnetic resonance imaging (mpMRI) with the identification of a new prostate imaging reporting and data system 5 lesion in one patient who underwent negative fusion biopsy. Five men underwent post-HoLEP PBx with progression in two patients, who both successfully underwent radical prostatectomy.
Men on AS for low-risk PCa can safely undergo HoLEP with significantly improved voiding parameters. Postoperative monitoring with PSA, mpMRI, and PBx can detect disease progression requiring definitive treatment. Further research is needed to optimize surveillance strategies and long-term cancer-specific outcomes.
对于患有下尿路症状（LUTS）且在积极监测（AS）低风险前列腺癌（PCa）时出现明显症状性前列腺增大的男性患者，其手术治疗方法尚未明确界定。我们报告了我们单机构对接受AS管理的低风险PCa男性患者进行钬激光前列腺剜除术（HoLEP）治疗LUTS的初步经验。
确定2013年至2019年间接受HoLEP的AS男性患者。分析术前癌症检查、前列腺特异性抗原（PSA）、围手术期结果和排尿参数的数据。评估PCa的术后监测情况，包括PSA最低点、前列腺磁共振成像、前列腺活检（PBx）以及最后一次随访时的PSA。
20名男性符合纳入标准。术前平均最大尿流率为7.9毫升/秒，排尿后残余尿量中位数为101立方厘米，经直肠超声检查的前列腺平均大小为99立方厘米。患者术前调整后的PSA中位数为8.5（四分位间距[IQR]：4.8 - 13.2）纳克/毫升。平均切除组织重量为65.5克，术后尿流率改善，残余尿量显著减少。20名男性中有5名患者的标本中发现PCa（均为Gleason分级1组）。术后PSA最低点中位数为1.2（IQR：0.5 - 1.8）纳克/毫升，中位数时间为5个月。在最后一次随访时（中位数18.5个月，IQR：10.5 - 37.8），术后PSA中位数为1.4（IQR：0.63 - 2.48）纳克/毫升。9名男性接受了术后多参数磁共振成像（mpMRI）检查，其中1名接受阴性融合活检的患者发现了新的前列腺影像报告和数据系统5级病变。5名男性接受了HoLEP术后PBx检查，2名患者病情进展，均成功接受了根治性前列腺切除术。
接受AS的低风险PCa男性患者可以安全地接受HoLEP治疗，排尿参数显著改善。通过PSA、mpMRI和PBx进行术后监测可以检测到需要确定性治疗的疾病进展。需要进一步研究以优化监测策略和长期癌症特异性结局。
