Comparative evaluation of palliative holmium laser enucleation and plasma kinetic prostate resection in the management of advanced prostate cancer with lower urinary tract symptoms.

This study aimed to evaluate the efficacy of palliative holmium laser enucleation of the prostate (HoLEP) versus plasma kinetic resection of the prostate (PKRP) in the management of advanced prostate cancer (APC) with concurrent lower urinary tract symptoms (LUTS).A retrospective analysis was conducted from February 2017 to March 2021, which included 41 patients with LUTS from two centers. Of these, 23 patients underwent palliative HoLEP and 18 underwent PKRP. Variables including age, prostate-specific antigen (PSA), prostate volume (V), Gleason Score, clinical staging, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), functional outcomes, and postoperative complications at 3, 6, and 12 months were compared. Kaplan-Meier survival curves were utilized to analyze overall survival (OS) and progression-free survival (PFS) in both groups, and a Cox proportional hazards regression model was employed to identify risk factors for mortality.Baseline characteristics were comparable between the two groups (p > 0.05). Both groups showed significant improvements in IPSS, Qmax, and post-void residual (PVR) were observed compared to baseline, with HoLEP showing greater enucleation efficiency and a significant improvement in Qmax. After one year of follow-up, the HoLEP group demonstrated a 96.0% reduction in PSA levels (from 84.5 to 3.4 ng/mL). Five patients required electrocoagulation for bleeding, but no Clavien Dindo IV complication, such as rectal injury, were reported. Kaplan-Meier analysis revealed that the 3-year PFS rates for the HoLEP and PKRP groups were 82.6% and 72.2%, respectively, with median survival times of 29.1 months (95% CI: 26.59 to 30.40) and 28.0 months (95% CI: 18.90 to 37.1). No statistically significant differences were found in OS (HR = 1.071, p = 0.884) and PFS (HR = 0.956, p = 0.907) between the groups. Cox regression analysis identified age (HR = 0.833; 95% CI: 0.749-0.928), clinical staging (HR = 0.336; 95% CI: 0.133-0.999), and Gleason Score (HR = 0.456; 95% CI: 0.217-0.958) as predictive risk factors for OS. For patients with APC and concurrent LUTS who are unresponsive to androgen deprivation therapy (ADT), surgical intervention such as palliative holmium laser enucleation and plasma kinetic prostate resection may be considered to temporarily relieve symptoms such as bladder outlet obstruction (BOO) and persistent hematuria.