Abstract

We evaluated the efficacy and outcome of laser photoselective vaporization of prostate (PVP) in patients with voiding difficulty due to prostatic obstruction induced by advanced prostate cancer (PC). We retrospectively studied the records of 13 patients with advanced PC and prostatic obstruction with a mean prostate volume of 65.0 ml. All of the 13 patients received PVP between 2006 and 2010 due to the symptoms of voiding difficulty or acute urinary retention (AUR, N = 10) refractory to medical treatment. Perioperative safety and functional results were evaluated. Lasering time ranged from 24 to 20 minutes (mean 67 ± 26), during which 66–423 KJ (mean 172 ± 95) of laser energy was delivered. All patients could resume voiding function with a mean catheterization time of 3.0 days. Our preliminary results suggest that PVP is a safe and effective procedure for relieving prostatic obstruction without intraoperative blood transfusion, water intoxication, or other complications in patients with advanced prostate cancer.

Abstract

Multiparametric Magnetic Resonance Imaging of the prostate (Mp‐MRI) allows the detection, localization and characterization of suspicious lesions for prostate cancer (PCa). When done prior to the diagnosis it also allows targeting of the biopsy, significantly improving the performance of the standard random prostate biopsy. Our goal is to compare a targeted biopsy technique (cognitive fusion) with the standard double sextant randomized prostate biopsy, and to determine which has better accuracy in the detection of cinically significant prostate cancer. 30 patients aged 61‐67 were selected with a PSA greater than 4 ng/mL (PSA between 5.6 – 19.2) and with suspicious PCa lesions on Mp‐MRI (Pi‐RADS 3‐5). A total of 75 suspicious lesions were detected. All biopsies were performed by the same Urologist (JMP), using trans‐rectal ultrasound guidance and after previous visualization of MRI images. Sampling was targeted to the area considered suspicious on MRI, using a Cognitive Fusion Technique, collecting two samples per area. After that, a double‐sextant standard prostate biopsy was also done in all patients. The variables used for statistical analysis were PCa detection rate and amount of cancer per sample. 22 patients were diagnosed with PCa. In 5 patients, cancer was only detected on targeted cores. Targeted biopsies diagnosed 17% more PCa when compared to random biopsies, and almost doubled the amount of cancer per sample. The overall PCa detection rate was 61% for all samples. 360 fragments were collected from standard randomized prostate biopsy, of which 169 were positive for PCa (47%), with a median Gleason score of 6 (3+3). The average amount of cancer per sample was 25% (5%‐85%). 105 of 150 fragments collected by cognitive fusion targeted biopsies were positive for PCa (70%). The median Gleason score was 7(3+4) with a median amount of cancer per sample of 45% (10%‐90%). Multiparametric prostatic MRI detects areas highly suspicious for PCa, allowing targeted biopsies, which increases diagnostic accuracy and improves the detection of clinically significant PCa.