Photoselective vaporization of the prostate in the management of lower urinary tract symptoms in prostate cancer patients on active surveillance Journal Article
| Authors: | Jibara, G.; Sjoberg, D. D.; Stearns, G. L.; Stabholz, Y.; Fathollahi, A.; Leddy, L. S.; Benfante, N.; Ehdaie, B.; Coleman, J. A.; Eastham, J. A.; Sandhu, J. S. |
| Article Title: | Photoselective vaporization of the prostate in the management of lower urinary tract symptoms in prostate cancer patients on active surveillance |
| Abstract: | Objective: To demonstrate the safety and efficacy of photoselective vaporization of the prostate in alleviating refractory lower urinary tract symptoms in prostate cancer patients who are managed with active surveillance and to explore the association of this procedure with prostate specific antigen (PSA) levels and cancer progression rates. Methods: Between 2008-2018, active surveillance patients who had refractory symptoms and needed surgery were studied. Perioperative functional variables were collected and analyzed. Disease progression was defined as an upgrade or upstage on surveillance biopsies or multiparametric prostate magnetic resonance imaging. Mean postop scores were estimated using locally-weighted methods. The risk of progression was reported using Kaplan-Meier's method. Results: Seventy-one patients were included in the study. The median age was 68 years and the median surveillance time before surgery was 4 years. At 12 months, there were substantial improvements in the mean International Prostate Symptom Score (18-5.9), maximum flow rate (6.8-14 mL/s), postvoid residual (240-73mL), PSA (8.1-5.2 ng/mL), and prostate volume (85-57mL). At 30-days, only 2 patients with grade-III complications. Late consequences included tissue regrowth in 4 and urethral stricture (requiring a single dilation) in 3 patients. PSA levels decreased by 36% at 12 months postoperatively. With a median follow-up of 3.7 years, 7 men progressed and received radical treatment. At 3 years, the probability of remaining on surveillance was 93% (95% CI 87%- 100%). Conclusion: Photoselective vaporization of the prostate offers substantial relief of symptoms in active surveillance patients with refractory symptoms, without adverse effects on disease progression rates. © 2021 Elsevier Inc. |
| Keywords: | adult; human tissue; aged; major clinical study; postoperative period; cancer growth; cancer patient; follow up; prostate specific antigen; retrospective study; risk assessment; prostate cancer; postoperative complication; probability; prostate biopsy; patient safety; scoring system; perioperative period; clinical effectiveness; cancer epidemiology; kaplan meier method; prostate surgery; laser therapy; prostate volume; lower urinary tract symptom; bladder obstruction; international prostate symptom score; multiparametric magnetic resonance imaging; human; male; article; urethra stenosis; antigen blood level; photoselective vaporization of the prostate; postvoid residual urine volume; urine flow rate |
| Journal Title: | Urology |
| Volume: | 156 |
| ISSN: | 0090-4295 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2021-10-01 |
| Start Page: | 225 |
| End Page: | 230 |
| Language: | English |
| DOI: | 10.1016/j.urology.2021.01.040 |
| PUBMED: | 33539897 |
| PROVIDER: | scopus |
| PMCID: | PMC8326299 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2021 -- Source: Scopus |
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