Photoselective Vaporization Safely Alleviates Refractory LUTS in Prostate Cancer Patients

By Matthew Phelan

February 25, 2021

NEW YORK (Reuters Health) - Photoselective vaporization of the prostate can provide relief from refractory lower-urinary-tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH) in prostate cancer patients managed by active surveillance, a new study suggests.

The noninvasive procedure, which carries a lower risk of complications than alternatives like transurethral resection of the prostate (TURP) or Holmium-laser enucleation, proved successful without accelerating cancer progression, researchers report in Urology.

"Photoselective vaporization of the prostate (PVP) is a minimally invasive procedure to remove excess prostate tissue in patients who are surgical candidates," explained co-author Dr. Ali Fathollahi of Memorial Sloan Kettering Cancer Center, in New York City.

"It uses a green-light laser. Unlike TURP, it is mostly a bloodless procedure to the extent that it can be done on patients who are on anticoagulants," he told Reuters Health by email.

Active surveillance (AS) is an increasingly popular option for men with low-grade, slow-growing tumors, many of whom may experience LUTS as a result of BPH.

For their study, Dr. Fathollahi and his colleagues analyzed data on 71 AS patients who received PVP at Sloan Kettering between 2008 and 2018. The men were monitored via prostate-specific antigen (PSA) tests and digital rectal examinations every six months.

All patients had undergone multiparametric prostate magnetic resonance imaging (mpMRI) within their first year, prior to their respective confirmatory biopsies, with a follow-up mpMRI repeated every 18 months. This included one mpMRI and biopsy at year 3 of AS.

The group's median age was 68 years, and the median surveillance time before PVP was four years.

A year after PVP, the men had a significant improvements in mean International Prostate Symptom Score, down from 18 to 5.9, and mean maximum urinary flow, up from 6.8 to 14 ml/s.

Furthermore, the patients' mean post-void residual volume had dropped from 240 to 73 ml, their PSA results from 8.1 to 5.2 ng/ml and their prostate volume from 85 to 57 ml - all significant changes.

Over a median follow-up of 3.7 years, seven of the 71 men saw their tumors progress, for which they received radical treatment.

Two patients had grade-3 complications during the first 30 days, while late consequences included tissue regrowth in four and urethral stricture in three patients.

Dr. Ryan P. Smith, a urologist at the University of Virginia, in Charlottesville, who was not involved in the study, said this group of patients "hasn't been well studied previously."

Prior research, notably the GOLIATH trial, has confirmed that PVP is as effective as the gold-standard TURP for removing benign prostate growths, he told Reuters Health by phone. The new findings, he said, further demonstrate the technique's efficacy for the unique subset of patients who are simultaneously undergoing PVP and active surveillance for prostate cancer.

"They did treat relatively large prostate glands and demonstrated good outcomes, with a very low complication rate and a high degree of symptomatic improvement in patients," Dr. Smith said of the authors.

He noted that the results were comparable to those seen in the GOLIATH study, although the new research looked at patients whose mean prostate volume at baseline was almost twice that of GOLIATH participants. "That's very encouraging."

The study had no commercial support, and the researchers report no conflicts of interest.

SOURCE: Urology, online February 1, 2021.