Shady Nafie1, John Dormer2, Masood A Khan2. 1. Department of Urology, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK. shady.nafie@me.com. 2. Department of Urology, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
Abstract
PURPOSE: Monopolar transurethral resection of the prostate is the gold standard for the treatment of benign prostatic hyperplasia. However, due to the associated risks of bleeding and TUR syndrome, laser prostate surgery is gaining popularity. We perform thulium-laser vaporesection of the prostate (TmLRP), where histological samples are generated in every case. We determined postoperative incidence and significance of prostate cancer detection, by retrospective histological examination of our cases. METHODOLOGY: Between October 2006 and August 2012, 223 patients underwent TmLRP by a single surgeon in our institution. With a background of a benign DRE, and no suspicion of CaP, histological results were studied. RESULTS: Mean age was 71 years (range 46-91), mean PSA was 4.1 ng/mL (range 0.1-20). 4.9% (11/223) had cancer prostate (CaP) diagnosed, with mean PSA of 6.9 ng/mL (range 0.7-14). Of these: 91% (10/11) had pT1b disease while 9% (1/11) had pT1a disease. Gleason score was 6 in 28% (3/11); 7 in 36% (4/11); 8 in 18% (2/11); 9 in and 18% (2/11). CONCLUSION: 4.9% of patients had unexpected CaP, with significant disease in 4.4% (pT1b) and 3.6% (Gleason score ≥7). Hence, patients should be advised of the small risk of missing significant unsuspected CaP after laser prostatectomy.
PURPOSE: Monopolar transurethral resection of the prostate is the gold standard for the treatment of benign prostatic hyperplasia. However, due to the associated risks of bleeding and TUR syndrome, laser prostate surgery is gaining popularity. We perform thulium-laser vaporesection of the prostate (TmLRP), where histological samples are generated in every case. We determined postoperative incidence and significance of prostate cancer detection, by retrospective histological examination of our cases. METHODOLOGY: Between October 2006 and August 2012, 223 patients underwent TmLRP by a single surgeon in our institution. With a background of a benign DRE, and no suspicion of CaP, histological results were studied. RESULTS: Mean age was 71 years (range 46-91), mean PSA was 4.1 ng/mL (range 0.1-20). 4.9% (11/223) had cancer prostate (CaP) diagnosed, with mean PSA of 6.9 ng/mL (range 0.7-14). Of these: 91% (10/11) had pT1b disease while 9% (1/11) had pT1a disease. Gleason score was 6 in 28% (3/11); 7 in 36% (4/11); 8 in 18% (2/11); 9 in and 18% (2/11). CONCLUSION: 4.9% of patients had unexpected CaP, with significant disease in 4.4% (pT1b) and 3.6% (Gleason score ≥7). Hence, patients should be advised of the small risk of missing significant unsuspected CaP after laser prostatectomy.
Authors: Peter J Gilling; Liam C Wilson; Colleen J King; Andre M Westenberg; Christopher M Frampton; Mark R Fraundorfer Journal: BJU Int Date: 2011-08-23 Impact factor: 5.588