Evaluating photoselective vaporization for urinary symptoms in patients with prostate cancer on active surveillance.

This study aimed to investigate the safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients with prostate cancer with lower urinary tract symptoms (LUTS) during active surveillance. The results suggested that PVP treatment was safe and effective in these patients.

Active surveillance (AS) is the main treatment for low-risk newly diagnosed prostate cancer (PCa). However, many patients under AS develop LUTS. LUTS include a weak urine stream, dribbling after urination, urgent and frequent urination, and waking up multiple times to urinate. LUTS are commonly associated with the large size of the prostate blocking urine flow, rather than the cancer itself. 

Medications can be used to ameliorate LUTS. However, some patients may need surgical procedures. Minimally invasive procedures such as PVP to alleviate LUTS are commonly used in benign prostatic hyperplasia (BPH; non-cancerous growth of the prostate gland). PVP uses a laser to clear (vaporize) the excess prostate tissue blocking urine flow. However, the safety, effectiveness, and oncological impact of PVP in patients with PCa and LUTS under AS are not known.

This study involved 71 patients with PCa under AS. All patients received PVP treatment for LUTS. Patients were followed up for an average of 3.7 years. 

At 12 months, patients had significant improvements in LUTS, including urine flow and the amount of urine remaining in the bladder after urination. There was an average decrease in urinary symptoms score from 18 to 5.9. The urine flow rates increased from 6.8 ml/s to 14 ml/s. Patients showed a decrease in residual urine volume after urination from 240 ml to 73 ml.

There was also a significant reduction in prostate-specific antigen (PSA) levels from 8.1 ng/ml to 5.2 ng/ml over 12 months. PSA is a protein made by the prostate gland that increases in PCa. There was also a significant reduction in prostate volume from 85 ml to 57 ml.

Prostate cancer progression occurred in 7 men who needed radical treatment such as prostate removal surgery or radiotherapy. Overall, the probability of the cancer not worsening was 100% after 12 months, 93% after 3 years, and 88% after 5 years.

The authors found that PVP is a safe and effective treatment option for patients with PCa and LUTS under active surveillance. 

This study had a small number of patients and was based on medical records. Information on sexual function was not available. The follow-up was also short.