Prostate Biopsy Need Not Substantially Delay Laser Enucleation

By David Douglas

December 28, 2020

NEW YORK (Reuters Health) - Holmium-laser enucleation of the prostate (HoLEP) to relieve bladder-outlet obstruction can be safely carried out within six weeks of transrectal ultrasound (TRUS)-guided prostate biopsy, according to a retrospective review.

Because urologists often treat patients with both an obstructive prostate and elevated prostate-specific antigen (PSA) levels, a biopsy is necessary before treating the enlarged prostate to make sure there is no cancer, explained Dr. Hemendra N. Shah of the University of Miami Miller School of Medicine, in Florida.

"Our study showed that there is no need to significantly delay treating an enlarged prostate with Holmium laser enucleation of the prostate following prostate biopsy, which is important as many men have very bothersome symptoms from their enlarged prostates and often want treatment as quickly as is safe," he told Reuters Health by email.

In a paper in Urology, Dr. Shah and colleagues note that a matter of particular concern in HoLEP candidates is that "prior prostate biopsy may induce inflammation, hematoma formation, and adhesions along the surgical plane, resulting in increased procedural difficulty."

The researchers reviewed data on all patients who underwent HoLEP conducted by a single surgeon at a hospital in Mumbai, India, between 2010 and 2016. The team focused on 552 patients of whom 82 underwent TRUS-guided 6- or 12-core prostate biopsy within 45 days of the procedure. The mean pre-HoLEP interval in this group was 17.7 days.

Following HoLEP, all patients were admitted for observation with continuous bladder irrigation. The urethral catheter was usually removed on the first postoperative day and they were discharged on the second postoperative day after an additional night of observation.

Compared with those who did not undergo biopsy and acted as controls, the study group showed significantly greater enucleation efficacy (1.32 g/min vs. 0.81 g/min). However, the study group had larger prostates than controls and enucleation efficacy correlates with prostate size.

Overall, there was no between-group difference in perioperative complications or postoperative voiding outcomes. Moreover, say the researchers, "in spite of prior TRUS guided prostate biopsy, incidental cancer detection was similar to (that in) patients from the control group who did not undergo a biopsy before their HoLEP procedure."

Dr. Bilal Chughtai, an associate professor of urology at New York Presbyterian Hospital-Weill Cornell, in New York City, told Reuters Health, "The important finding of this paper is that undergoing a transrectal ultrasound-guided biopsy of the prostate does not negatively impact the outcomes of holmium enucleation of the prostate."

"Therefore," said Dr. Chughtai, who was not involved in the study, "men who have high PSAs and need prostate biopsies do not need to unnecessarily delay their procedure to wait for inflammation etc. to subside. The other finding was that 4.8% of men were found to have prostate cancer despite undergoing a prostate biopsy, but most of these cancers were clinically insignificant."

SOURCE: https://bit.ly/3gAD5bl Urology, online November 20, 2020.

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