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Lamersdorf T, Netsch C, Becker B, Wülfing C, Anheuser P, Engel O, Gross AJ, Rosenbaum CM. Influence of Prostate Cancer on Thulium Vapoenucleation of the Prostate-A Multicentre Analysis. J Clin Med 2023; 12:jcm12031174. [PMID: 36769821 PMCID: PMC9918181 DOI: 10.3390/jcm12031174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/10/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are common in elderly men. Data on the laser-based surgery known as thulium vapoenucleation of the prostate (ThuVEP) in PCa patients are rare. Our objective was to analyse the feasibility, safety and functional outcome of ThuVEP in patients with lower urinary tract symptoms (LUTS) and PCa. Methods: Multicentre study, including 1256 men who underwent ThuVEP for LUTS. Maximum urinary flow rate (Qmax) and post-void residual volume (PVR) were measured perioperatively. The International Prostate Symptome Score (IPSS) was measured perioperatively and at follow-up (FU). Perioperative complications were captured. Reoperation rate was captured at FU. Results: Of 994 men with complete data, 286 (28.8%) patients had PCa. The most common Gleason score was 3 + 3 in 142 patients (49.7%). Most common was low-risk PCa (141 pts; 49.3%). PCa patients were older, had smaller prostates and had higher prostate-specific antigen (PSA) values (all p < 0.001). Comparing non-PCa and PCa patients, no differences occurred perioperatively. IPSS, quality of life and PVR decreased (all p < 0.001) and Qmax improved (p < 0.001) in both groups. Reoperation rates did not differ. The results of low- vs. intermediate-/high-risk PCa patients were comparable. Conclusion: ThuVEP is a safe and long-lasting treatment option for patients with LUTS with or without PCa. No differences occurred when comparing low- to intermediate-/high-risk PCa patients.
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Affiliation(s)
- Tobias Lamersdorf
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Benedikt Becker
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Hospital Altona, 22763 Hamburg, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Hospital Wandsbek, 22043 Hamburg, Germany
| | - Oliver Engel
- Department of Urology, Asklepios Hospital Harburg, 21075 Hamburg, Germany
| | - Andreas J. Gross
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
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Jibara G, Sjoberg DD, Stearns GL, Stabholz Y, Fathollahi A, Leddy LS, Benfante N, Ehdaie B, Coleman JA, Eastham JA, Sandhu JS. Photoselective Vaporization of the Prostate in the Management of Lower Urinary Tract Symptoms in Prostate Cancer Patients on Active Surveillance. Urology 2021; 156:225-230. [PMID: 33539897 DOI: 10.1016/j.urology.2021.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Ghalib Jibara
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center, NY
| | | | - Yariv Stabholz
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Ali Fathollahi
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Laura S Leddy
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Nicole Benfante
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center, NY
| | - Behfar Ehdaie
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Jonathan A Coleman
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - James A Eastham
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Jaspreet S Sandhu
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
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Furusawa J, Yamada Y, Soga N, Kuromatsu I. Optimal Monitoring of Prostate-Specific Antigen Detects Prostate Cancer at the Localized Stage after Photoselective Vaporization for Benign Prostatic Hyperplasia. Curr Urol 2019; 12:147-152. [PMID: 31316323 DOI: 10.1159/000489433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/24/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Photoselective vaporization of the prostate (PVP) does not provide prostate tissue for pathologic analysis. Here, we carried out early monitoring for prostate cancer by measuring prostate-specific antigen (PSA) levels and assessing clinicopathological features after PVP. Materials and Methods Patients (n = 800) who underwent PVP and were followed-up for more than 12 months were analyzed retrospectively. After PVP, PSA levels were measured at 3 and 12 months and each year thereafter. Prostate biopsies were performed when PSA levels increased continuously. We assessed the characteristics of patients diagnosed with prostate cancer. Results The mean follow-up period was 49 months. After PVP, 54 patients underwent biopsies, and 23 patients were diagnosed with prostate cancer. Overall, 10, 10, and 3 patients had clinical stage T1c, T2a, and T2b disease, respectively, and there were no cases of stage T2c disease or greater. Conclusions We found that it was possible to diagnose prostate cancer at a localized stage under our optimal PSA monitoring schedule before and after PVP.
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Affiliation(s)
- Jun Furusawa
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yamada
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Norihito Soga
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Isao Kuromatsu
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan
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Tsushima T, Miura T, Hachiya T, Nakamura I, Yamato T, Kishida T, Tanaka Y, Irie S, Meguro N, Kawahara T, Nakajima N. Treatment Recommendations for Urological Symptoms in Cancer Patients: Clinical Guidelines from the Japanese Society for Palliative Medicine. J Palliat Med 2018; 22:54-61. [PMID: 30289332 DOI: 10.1089/jpm.2018.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Urological symptoms such as gross hematuria, lower and upper urinary tract symptoms, and bladder pain are common in and distressing for patients with advanced cancer. Although palliation of urological symptoms is important to improve the quality of life of cancer patients and their families and caregivers, clinical guidelines for managing urological symptoms in patients with cancer have not been published. METHODS Following the formal guideline development process, the Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of urological symptoms in patients with cancer. RESULTS This article summarizes the recommendations and their rationales and provides a short summary of the development process of the JSPM urological symptom management guidelines. We established five recommendations, all of which were based on the best available evidence and expert consensus. CONCLUSION JSPM released the first edition of the "Clinical Guidelines for Urological Symptoms in Cancer Patients." Future clinical research and continuous guideline updates are required to improve the quality of managing urological symptoms in patients with cancer.
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Affiliation(s)
- Tomoyasu Tsushima
- 1 Department of Urology, National Hospital Organization Okayama Medical Center , Okayama, Japan
| | - Takafumi Miura
- 2 Department of Urology, Secomedic Hospital , Funabashi, Japan
| | - Takahiko Hachiya
- 3 Department of Urology, Kasukabe Medical Center , Kasukabe, Japan
| | - Ichiro Nakamura
- 4 Department of Urology, Kobe City Medical Center West Hospital , Kobe, Japan
| | - Toyoko Yamato
- 5 General Foundation Corporation Junpukai Health Management Center , Kurashiki, Japan
| | - Takeshi Kishida
- 6 Department of Urology, Kanagawa Cancer Center Hospital , Yokohama, Japan
| | - Yoshinori Tanaka
- 7 Department of Urology, Japanese Red Cross Musashino Hospital , Musashino, Japan
| | - Shin Irie
- 8 Department of Urology, Kurashiki City Hospital , Kurashiki, Japan
| | | | - Takashi Kawahara
- 10 Department of Urology, University of Tsukuba , Tsukuba, Japan
| | - Nobuhisa Nakajima
- 11 Division of Community-Based Medicine and Primary Care, University of the Ryukyus Hospital , Nakagami-gun, Japan
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Becker A, Placke A, Kluth L, Schwarz R, Isbarn H, Chun F, Heuer R, Schlomm T, Seiler D, Engel O, Fisch M, Graefen M, Ahyai SA. Holmium Laser Enucleation of the Prostate Is Safe in Patients with Prostate Cancer and Lower Urinary Tract Symptoms—A Retrospective Feasibility Study. J Endourol 2014; 28:335-41. [DOI: 10.1089/end.2013.0432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Andreas Becker
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Placke
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Luis Kluth
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Schwarz
- Department of Radiation Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik Isbarn
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Chun
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Heuer
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schlomm
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Seiler
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Oliver Engel
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha A. Ahyai
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Osterberg EC, Choi BB. Review of current laser therapies for the treatment of benign prostatic hyperplasia. Korean J Urol 2013; 54:351-8. [PMID: 23789041 PMCID: PMC3685632 DOI: 10.4111/kju.2013.54.6.351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/20/2013] [Indexed: 12/11/2022] Open
Abstract
The gold standard for symptomatic relief of bladder outlet obstruction secondary to benign prostatic hyperplasia has traditionally been a transurethral resection of the prostate (TURP). Over the past decade, however, novel laser technologies that rival the conventional TURP have multiplied. As part of the ongoing quest to minimize complications, shorten hospitalization, improve resection time, and most importantly reduce mortality, laser prostatectomy has continually evolved. Today, there are more variations of laser prostatectomy, each with several differing surgical techniques. Although abundant data are available confirming the safety and feasibility of the various laser systems, future randomized-controlled trials will be necessary to verify which technique is superior. In this review, we describe the most common modalities used to perform a laser prostatectomy, mainly, the holmium laser and the potassium-titanyl-phosphate lasers. We also highlight the physical and clinical characteristics of each technology with a review of the most current and highest-quality literature.
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