Photoselective Vaporization of the Prostate in the Management of Lower Urinary Tract Symptoms in Prostate Cancer Patients on Active Surveillance
| Autor: | Jonathan A. Coleman, Jaspreet S. Sandhu, Ali Fathollahi, Behfar Ehdaie, Daniel Sjöberg, James A. Eastham, Yariv Stabholz, Nicole Benfante, Gillian Stearns, Ghalib Jibara, Laura Leddy |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Urology 030232 urology & nephrology Article 03 medical and health sciences Prostate cancer 0302 clinical medicine Lower Urinary Tract Symptoms Prostate Lower urinary tract symptoms medicine Humans Adverse effect Watchful Waiting Aged Retrospective Studies Prostatectomy business.industry Cancer Prostatic Neoplasms Perioperative Middle Aged medicine.disease Prostate-specific antigen medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis International Prostate Symptom Score Laser Therapy business |
| Zdroj: | Urology |
| ISSN: | 1527-9995 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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