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Relationships between holmium laser enucleation of the prostate and prostate cancer

Nature Reviews Urology volume 20, pages 226–240 (2023)Cite this article

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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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Fig. 1: Prostate zones during BPH surgery.
Fig. 2: Surgical steps of HoLEP.
Fig. 3: Diagnostic pathway of patients undergoing HoLEP at Northwestern University.

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Authors and Affiliations

  1. Ohio State University School of Medicine, Department of Urology, Columbus, OH, USA

    Matthew S. Lee

  2. University of Calgary, Institute of Urology, Calgary, Alberta, Canada

    Mark A. Assmus

  3. Feinberg School of Medicine, Northwestern University, Department of Urology, Chicago, IL, USA

    Jenny Guo, Mohammad R. Siddiqui, Ashley E. Ross & Amy E. Krambeck

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M.S.L., J.G., M.R.S. and A.E.R. researched data for the article. All authors contributed substantially to discussion of the content. M.S.L., J.G., M.R.S., A.E.R. and A.E.K. wrote the article. M.S.L., M.A.A., A.E.R. and A.E.K. reviewed and edited the manuscript before submission.

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M.S.L. is a consultant for Lumenis. A.E.R. is a consultant for Astellas Pharma Global Development, Inc, Bayer HealthCare Pharmaceuticals, Inc, Blue Earth Diagnostics Ltd, Decipher Biosciences, Inc, Janssen Biotech, Inc, Lantheus Medical Imaging, Inc, Myovant Sciences, Pfizer, Inc, and Tempus Health, Inc. A.E.K. is a consultant for Ambu, Boston Scientific, Lumenis, Karl Storz, Uriprene, and Virtuoso Surgical. A.E.K. is also a board member of Sonomotion. The other authors declare no competing interests.

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Lee, M.S., Assmus, M.A., Guo, J. et al. Relationships between holmium laser enucleation of the prostate and prostate cancer. Nat Rev Urol 20, 226–240 (2023). https://doi.org/10.1038/s41585-022-00678-y

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