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Focal Laser Ablation of Prostate Cancer: An Office Procedure
Published on: March 30, 2021
Two laser ablation techniques for a prostate less than 60 mL: lessons learned 70 months after a randomized controlled
Ahmed M Elshal1, Hazem M Elmansy, Mostafa M Elhilali
1Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
Urology
|June 25, 2013
Summary
Photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HOLAP) offer comparable long-term outcomes for benign prostatic hyperplasia. Bladder neck contracture is a key predictor of early retreatment, especially in smaller prostates.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Laser Therapeutics
Background:
- Symptomatic benign prostatic hyperplasia (BPH) affects a significant portion of the aging male population.
- Laser ablation techniques, including holmium laser ablation of the prostate (HOLAP) and photoselective vaporization of the prostate (PVP), are established BPH treatments.
- Long-term outcomes and predictors of success for these laser modalities require continued investigation.
Purpose of the Study:
- To compare the long-term efficacy and safety of HOLAP and PVP in treating symptomatic BPH.
- To identify predictors of long-term negative outcomes after laser prostate ablation.
- To conduct a cost analysis of both treatment modalities.
Main Methods:
- A randomized trial involving 109 patients with prostate volume < 60 mL.
- Patients were randomized to either HOLAP (n=57) or PVP (n=52) using an 80-W potassium titanyl phosphate laser.
- Outcome parameters included subjective (IPSS QoL, IIEF-15) and objective (PVR, Qmax) measures, assessed over a median follow-up of 71.3 months. Cost analysis was performed.
Main Results:
- Both HOLAP and PVP demonstrated comparable and significant improvements in all assessed urinary parameters from baseline.
- Retreatment rates for infravesical obstruction were similar (19.2% HOLAP vs. 25% PVP).
- Smaller prostate volume was significantly associated with bladder neck contracture (BNC); BNC and urethral stricture were primary causes for early reintervention. Lower postoperative PSA reduction (<20%) predicted redo treatment for recurrent adenoma. PVP had slightly higher procedural costs.
Conclusions:
- PVP and HOLAP are equally effective and safe for symptomatic BPH, with similar long-term outcomes and costs.
- Approximately 1 in 5 patients may require retreatment regardless of the laser used.
- Bladder neck contracture is a prevalent cause of early retreatment in smaller glands for both laser types. Reduced postoperative PSA warrants monitoring for residual tissue.
