Photoselective Vaporization of the Prostate in the Management of Lower Urinary Tract Symptoms in Prostate Cancer Patients on Active Surveillance.

Autor: Jibara G; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY., Sjoberg DD; Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center, NY., Stearns GL; Urology Service, University of Vermont, Burlington, VT., Stabholz Y; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY., Fathollahi A; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY., Leddy LS; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY., Benfante N; Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center, NY., Ehdaie B; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY., Coleman JA; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY., Eastham JA; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY., Sandhu JS; Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY.
Jazyk: angličtina
Zdroj: Urology [Urology] 2021 Oct; Vol. 156, pp. 225-230. Date of Electronic Publication: 2021 Feb 02.
DOI: 10.1016/j.urology.2021.01.040
Abstrakt: Objective: To demonstrate the safety and efficacy of photoselective vaporization of the prostate in alleviating refractory lower urinary tract symptoms in prostate cancer patients who are managed with active surveillance and to explore the association of this procedure with prostate specific antigen (PSA) levels and cancer progression rates.
Methods: Between 2008-2018, active surveillance patients who had refractory symptoms and needed surgery were studied. Perioperative functional variables were collected and analyzed. Disease progression was defined as an upgrade or upstage on surveillance biopsies or multiparametric prostate magnetic resonance imaging. Mean postop scores were estimated using locally-weighted methods. The risk of progression was reported using Kaplan-Meier's method.
Results: Seventy-one patients were included in the study. The median age was 68 years and the median surveillance time before surgery was 4 years. At 12 months, there were substantial improvements in the mean International Prostate Symptom Score (18-5.9), maximum flow rate (6.8-14 mL/s), postvoid residual (240-73mL), PSA (8.1-5.2 ng/mL), and prostate volume (85-57mL). At 30-days, only 2 patients with grade-III complications. Late consequences included tissue regrowth in 4 and urethral stricture (requiring a single dilation) in 3 patients. PSA levels decreased by 36% at 12 months postoperatively. With a median follow-up of 3.7 years, 7 men progressed and received radical treatment. At 3 years, the probability of remaining on surveillance was 93% (95% CI 87%- 100%).
Conclusion: Photoselective vaporization of the prostate offers substantial relief of symptoms in active surveillance patients with refractory symptoms, without adverse effects on disease progression rates.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: