Photoselective Vaporization of the Prostate in the Management of Lower Urinary Tract Symptoms in Prostate Cancer Patients on Active Surveillance.

Abstract

OBJECTIVES\nTo 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 PSA levels and cancer progression rates.\n\n\nMETHODS\nBetween 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 mpMRI s. Mean post-op scores were estimated using locally-weighted methods. The risk of progression was reported using Kaplan-Meier s method.\n\n\nRESULTS\nSeventy-one patients were included in the study. The median age was 68 yrs and the median surveillance time before surgery was 4 yrs. At 12 months, there were substantial improvements in the mean International Prostate Symptom Score (18 to 5.9), maximum flow rate (6.8 to 14 ml/s), post-void residual (240 to 73ml), PSA (8.1 to 5.2 ng/ml), and prostate volume (85 to 57ml). At 30-days, only two patients with grade-III complications. Late consequences included tissue regrowth in four and urethral stricture (requiring a single dilation) in three patients. PSA levels decreased by 36% at 12 months post-operatively. With a median follow-up of 3.7 years, seven men progressed and received radical treatment. At three years, the probability of remaining on surveillance was 93% (95% CI 87%- 100%).\n\n\nCONCLUSIONS\nPhotoselective vaporization of the prostate offers substantial relief of symptoms in active surveillance patients with refractory symptoms, without adverse effects on disease progression rates.