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Elsaqa M, El Tayeb MM. The Role of Transurethral BPH Surgeries in Management of Urinary Symptoms in Prostate Cancer Patients, Narrative Review. Curr Urol Rep 2024; 26:7. [PMID: 39352587 PMCID: PMC11445351 DOI: 10.1007/s11934-024-01229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/04/2024]
Abstract
PURPOSE OF REVIEW Prostate cancer and benign prostate hyperplasia (BPH) are two ubiquitous pathologies that may coexist. A significant percentage of patients with different stages of prostate cancer suffer lower urinary tract symptoms (LUTS) due to associated BPH. We aimed to review the literature regarding the role of transurethral surgeries in the management of prostate cancer patients and the different available management options. RECENT FINDINGS The evidence in literature for the use of BPH surgeries in prostate cancer patients is based mainly on low-quality retrospective studies. In patients on active surveillance, BPH surgeries are beneficial in relieving LUTS without oncological risk and can eliminate the contribution of adenoma to PSA level. In patients with advanced prostate cancer, palliative BPH surgery can relieve LUTS and urinary retention with unclear oncological impact; however some reports depict that the need for BPH surgery in advanced prostate cancer is associated with poorer prognosis. In patients receiving radiotherapy, various studies showed that transurethral resection of prostate (TURP) is associated with increased radiotoxicity despite some recent reports encouraging the use of Holmium Laser Enucleation of the Prostate (HoLEP) to improve urinary symptom scores before radiotherapy. The most commonly reported techniques utilized are TURP, photoselective vaporization of prostate (PVP) and HoLEP. The use of BPH surgery is justified for relieving LUTS in selected prostate cancer patients on active surveillance or in advanced stages, however the use in the pre-radiotherapy settings remains controversial. Future prospective and randomized controlled trials are required for validating the benefits and assessing potential hazards.
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Affiliation(s)
- Mohamed Elsaqa
- Alexandria University Faculty of Medicine, Sultan Hussein Street, Alazarita, Alexandria, 21131, Egypt.
| | - Marawan M El Tayeb
- Division of Urology, Department of Surgery, Baylor Scott & White Health, Temple, TX, USA
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Shi Y, Cao T, Xu J, Cui D, Wang X, Zhu Y, Ruan Y, Han B, Xia S, Chen Y, Guo W, Jing Y. Simultaneous thulium laser resection of the prostate and transperineal prostate biopsy in clinically diagnosed metastatic prostate cancer with bladder outlet obstruction. Lasers Med Sci 2023; 38:188. [PMID: 37596454 DOI: 10.1007/s10103-023-03848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/03/2023] [Indexed: 08/20/2023]
Abstract
Metastatic prostate cancer (mPCa) patients complicated with bladder outlet obstruction (BOO) are often referred to a urologist. Androgen deprivation therapy (ADT) combined with indwelling catheter usually be the initial management. To retrospectively analysis the safety and efficacy of simultaneous thulium laser resection of the prostate (TmLRP) and transperineal prostate biopsy in metastatic prostate cancer with bladder outlet obstruction. From January 2016 to December 2021, 67 clinically diagnosed mPCa with BOO patients were included in this study. All patients were preoperatively assessed with international prostate symptom score (IPSS), QoL, serum prostate-specific antigen (PSA), prostate volume evaluation by transrectal ultrasound, postvoid residual urine volume (PVR), and maximum flow rate (Qmax). Preoperative and perioperative parameters at 1-, 3-, and 6-month follow-up were also evaluated. All complications were recorded. Simultaneous TmLRP and transperineal prostate biopsy had obvious advantages for clinically diagnosed mPCa patients with BOO, including short overall operation time (52 ± 23.3 min), little hemoglobin decrease (0.6 ± 0.7 g/l), and short hospital stay (average 3.8 days). In addition, simultaneous TmLRP and transperineal prostate biopsy also brought them significant improvement on IPSS, QoL score, Qmax, and PVR volume (P < 0.001) at 1-, 3-, and 6-month follow-up after operation compared to preoperative parameters. Complications were in a low incidence. Simultaneous TmLRP and transperineal prostate biopsy is a bloodless operation with immediate effect and little perioperative complication. Importantly, it is a promising technology in the diagnosis and treatment of clinically diagnosed mPCa patients with BOO.
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Affiliation(s)
- Youwei Shi
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Tianyu Cao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Junhao Xu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Di Cui
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xiaohai Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yiping Zhu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yuan Ruan
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Bangmin Han
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yuee Chen
- Department of Urology, Nanping First Hospital Affiliated to Fujian Medical University, Fujian, 353006, China.
| | - Wenhuan Guo
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Yifeng Jing
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Lv C, Yuan Q, Yan J, Sun B, Zhang X. Commentary: The impact of palliative transurethral resection of the prostate on the prognosis of patients with bladder outlet obstruction and metastatic prostate cancer: A population-matched study. Front Surg 2023; 10:1123602. [PMID: 36843985 PMCID: PMC9945581 DOI: 10.3389/fsurg.2023.1123602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023] Open
Affiliation(s)
- Chao Lv
- Department of Urology, PLA Air Force Medical Center, Beijing, China
| | - Qing Yuan
- Department of Urology, 3rd Medical Center of PLA General Hospital, Beijing, China
| | - JingMin Yan
- Department of Urology, PLA Air Force Medical Center, Beijing, China
| | - Bin Sun
- Department of Urology, PLA Air Force Medical Center, Beijing, China
| | - Xu Zhang
- Department of Urology, 3rd Medical Center of PLA General Hospital, Beijing, China,Correspondence: Xu Zhang
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Relationships between holmium laser enucleation of the prostate and prostate cancer. Nat Rev Urol 2022; 20:226-240. [PMID: 36418491 DOI: 10.1038/s41585-022-00678-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a size-independent surgical option for treating benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) with excellent, durable functional outcomes. The prevalence of LUTS secondary to BPH and prostate cancer both increase with age, although the two diseases develop independently. Urologists often face a diagnostic dilemma, as men with LUTS secondary to BPH might also present with an elevated PSA and, therefore, need a diagnostic work-up to exclude prostate cancer. Nevertheless, ~15% of men with a negative elevated PSA work-up will undergo HoLEP and will be diagnosed with incidental prostate cancer at the time of HoLEP. Indeed, prostate cancer is often found in men undergoing HoLEP, and this situation can be challenging to manage. Variables associated with the detection of incidental prostate cancer, strategies to reduce incidental prostate cancer, as well as the natural history and management of this condition have been extensively studied, but further work in this area is still needed.
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Peng Z, Huang A. Cytoreductive radical prostatectomy or radiation therapy for metastases prostate cancer: Evidence from meta-analysis. Medicine (Baltimore) 2022; 101:e30671. [PMID: 36197186 PMCID: PMC9509142 DOI: 10.1097/md.0000000000030671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cytoreductive radical prostatectomy (RP), transurethral resection of the prostate, and radiation therapy were the main local treatments for oligometastatic prostate cancer (PCa). An optimal local treatment for metastases PCa was not consensus. The purpose of this study was to evaluate the effect on these local treatments for patients with metastases PCa. METHODS All relevant studies were systematically searched through PubMed, Web of Science through November 1, 2021. Studies were screened by inclusion and exclusion criteria. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated by this meta-analysis. RESULTS Eleven studies were identified that met the inclusion criteria. 644 patients received cytoreductive surgery, 8556 patients received no surgery or radiation therapy (RT), and 461 patients received RP + androgen deprivation therapy compared with 746 patients who received RT. Pooled data indicated that cytoreductive surgery significantly prolonged the PFS (OR = 0.65, 95% CI 0.53-0.80, P < .0001), CSS and OS (OR = 0.49, 95% CI 0.43-0.56, P < .00001; and OR = 0.80, 95% CI 0.72-0.88, P < .00001; respectively). Comparing cytoreductive surgery with RT, CSS, and OS were similar (OR = 0.82, 95% CI 0.67-1.01, P = .06; and OR = 0.93, 95% CI 0.79-1.09, P = .39; respectively). CONCLUSIONS Cytoreductive radical prostatectomy significantly prolonged the PFS for metastatic PCa. Although OS was considered a-not-so significant difference between cytoreductive surgery and non-local therapy, non-local treatment was not recommended.
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Affiliation(s)
- Zhixiong Peng
- Department of Surgery, Traditional Chinese Medicine Hospital of Yichun City, Yichun City, China
- *Correspondence: Zhixiong Peng, Department of Surgery, Traditional Chinese Medicine Hospital of Yichun City, 357 Zhongshan Road, Yichun City, Jiangxi Province, China (e-mail: )
| | - Andong Huang
- Department of Urology, Yichun Zhegan Friendship Hospital, Yichun City, China
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The role of surgery for loco-regional and advanced urological cancers. Curr Opin Urol 2022; 32:634-642. [PMID: 36101519 DOI: 10.1097/mou.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is a general misconception that surgery is the antithesis of palliation. However, symptom mitigation, the basic tenet of palliative interventions, can be achieved by invasive procedures. Surgical care, thus, plays an important role in palliative oncology, alongside radiation and systemic therapy. There is global movement to improve palliation in oncology, and thus it is timely to evaluate the role of surgical interventions can play in this setting. RECENT FINDINGS Many of the surgical interventions done with palliative intent were first established as curative options. Most studies looked at interventions for local control of primary tumour including extirpative surgeries, while some studies studied pain relief for bone metastases. Results show that patients have an acceptable survival outcome and complication rate comparable to those done in the curative setting. However, not all studies report functional outcomes and symptom-relief consistently, highlighting an unmet need. SUMMARY More studies are needed to further define the role of surgery in palliative care. Randomized controlled trials studying surgical intervention in the palliative setting will be challenging because of lack of equipoise, inherent bias in patient and disease characteristics in those who undergo surgery. Nonetheless, studies should endeavour to study symptom-free survival and PROMs as meaningful endpoints of interventions performed in a palliative setting rather than solely focus on hard oncological endpoints of survival.
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