Anatomic and Clinical Effects of Focal Laser Ablation of the Prostate on Symptomatic Benign Prostatic Hyperplasia

Laser ablation is a promising technique for tissue-debulking in patients with symptomatic benign prostatic hyperplasia (BPH). This study evaluated the effects of focused laser ablation of the prostate (FLA) on urinary symptoms for patients with BPH.

Since 2018, 62 patients had bilateral prostate FLA for prostate cancer and/or symptomatic BPH, defined as an international prostate symptom score (IPSS) ≥11, and have 6-month follow-up data. Urinary and sexual health were scored with standardized surveys while imaging defined prostate anatomy. FLA was performed as an outpatient procedure with either transrectal MRI-guided (n = 24) or transperineal ultrasound-guided (n = 38) laser fiber placement to debulk the prostate and/or ablate cancer foci plus margins. Enhanced prostate MRI was performed immediately or up to 2 days later to assess the treatment zones. Follow-up then consisted of PSA levels every 6 months and MRI at 6-12 months and then yearly combined with patient sexual/urinary surveys and clinical assessments.

All patients had technically successful FLA and 6-month clinical and imaging follow-up. At 6-month follow-up, mean IPSS was reduced by 43% relative to baseline (10.4 vs. 18.4), mean prostate volume was reduced by 30% (42.2 vs. 60.5 mL), and mean PSA was reduced by 58% (4.3 vs. 10.2 ng/mL). All of these changes were statistically significant (p ≤ 0.008). Compared with baseline, there was no significant change in the SHIM score at 6 months (16.0 vs. 16.8; p = 0.59). In a subset of patients for whom 12-month data were available, there were significant reductions in PSA (61%; 4.1 vs. 10.5 ng/mL; p < 0.002) and IPSS (45%; 9.9 vs. 17.9; p < 0.002), while the 12-month SHIM score was not significantly different from baseline (15.2 vs. 16.0; p = 0.27). Mean laser irradiation time was 19 min with a mean energy deposition of 13,562 J. The most frequent adverse events were prolonged urinary catheterization in 10 patients (16%) and urinary tract infection in 8 (13%).

FLA is a safe and effective tissue-debulking technique for patients with symptomatic BPH. This outpatient procedure requires minimal procedure time and can be performed without the need for operating rooms or cystoscopy. Our results are consistent with those of previous studies indicating that FLA preserves sexual function.