Aquablation for LUTS due to BPH in men with localized prostate cancer

Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are common in aging men and are often concomitant. The purpose of the study was to evaluate whether Aquablation in men with BPH and early-stage PCa resulted in improvements in lower urinary tract symptoms (LUTS) and urinary quality of life (QoL) similar to men with only BPH. Furthermore, we explored active surveillance (AS) cancer outcomes in men undergoing Aquablation compared with a control AS population.

Two prospective IRB (institutional review board)-approved databases were used to investigate outcomes in men with GG1 PCa on AS and men with LUTS due to BPH treated with Aquablation. Clinical and demographic data were collected. AS was performed per institutional protocol, and all men undergoing Aquablation did so for relief of symptomatic LUTS/BPH. Between-group comparisons were made using Analysis of variance, with multiple pairwise comparisons or Chi-squared tests were used to compare baseline demographics. Urinary outcomes at baseline, 6 weeks, and 6 months were compared between subgroups using t-tests.

1445 men were included in the analysis: 914 on AS, 478 without PCa who underwent Aquablation, and 53 on AS who underwent Aquablation. Aquablation resulted in significant improvement in IPSS, QoL, and Qmax in both groups undergoing Aquablation. AS patients who underwent Aquablation had 44% fewer pathologic upgrading events than AS patients who did not undergo Aquablation. This corresponds to a freedom from progression hazard ratio of 0.48 (95%CI [0.24, 0.98], p = 0.044).

Aquablation is safe and effective for the treatment of LUTS due to BPH in men on AS for early-stage prostate cancer. Additionally, Aquablation in men undergoing AS is associated with a lower risk of pathologic upgrading and favorably alters the oncologic outcomes.