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Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
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Holmium Laser Enucleation of Prostate in Patients with Pre-Existing Localized Prostate Cancer, Dual Center Study
Mohamed Elsaqa1,2, Austen Slade3, James Lingeman3
1Division of Urology, Department of Surgery, Baylor Scott and White Health, Temple, Texas, USA.
Journal of Endourology
|December 4, 2022
Summary
Holmium laser enucleation of the prostate (HoLEP) effectively manages enlarged prostates in prostate cancer (PCa) patients, improving urinary symptoms and aiding PCa management plans. This minimally invasive procedure reduces prostate size, leading to better prostate-specific antigen (PSA) monitoring and potentially preventing overtreatment.
Area of Science:
- Urology
- Oncology
- Minimally Invasive Surgery
Background:
- Holmium laser enucleation of the prostate (HoLEP) is an established minimally invasive treatment for benign prostatic hyperplasia.
- Its utility in prostate cancer (PCa) patients, particularly those on active surveillance or requiring prostate debulking before radiation, requires further elucidation.
Purpose of the Study:
- To evaluate the role and impact of HoLEP in managing PCa patients with bothersome lower urinary tract symptoms (LUTS) on active surveillance.
- To assess HoLEP's effectiveness in prostate debulking prior to radiation therapy.
- To analyze the effect of HoLEP on prostate-specific antigen (PSA) levels and subsequent PCa management strategies.
Main Methods:
- A prospective database from two institutions was reviewed for PCa patients who underwent HoLEP.
- Included patients had localized PCa and at least one year of follow-up.
- Data collected included PSA trends, International Prostate Symptom Score (IPSS) changes, and modifications in PCa management plans.
Main Results:
- 117 PCa patients with a median follow-up of 30 months were analyzed.
- HoLEP significantly reduced median PSA levels at 6 weeks, 3 months, and 1 year post-procedure (p < 0.001).
- Mean IPSS scores showed significant improvement at all follow-up points (p < 0.001).
- 88% of patients remained on active surveillance, while 23% received radiotherapy ± androgen deprivation therapy.
- Among 36 intermediate-risk patients, 41.6% received radiotherapy, and 58.3% continued active surveillance.
Conclusions:
- HoLEP is beneficial for debulking large prostates in PCa patients experiencing LUTS on active surveillance or awaiting radiotherapy.
- The procedure aids in more accurate PSA monitoring by reducing the influence of benign prostatic hyperplasia volume.
- HoLEP can help refine PCa management decisions, potentially reducing overtreatment.
