Enlarged prostate: decade-long study demonstrates immediate and long-term benefits of holmium laser treatment
New research presented at the Annual Meeting of the American Urology Association (AUA) in Washington, DC demonstrates that holmium laser therapy is a safe and durable treatment option for Benign Prostatic Hyperplasia (BPH) – an enlargement of the prostate that affects most men as they age. The study, conducted by researchers from the McGill University Health Centre (MUHC), is the longest comprehensive assessment of this technology to date, and researchers suggest it may now safely be considered the new, size independent, gold standard for treatment of BPH.
A man’s prostate naturally increases in size throughout life, but can occasionally reach a very large size placing pressure on the urethra and causing urination difficulties and bladder problems. A prostate of 40-60 grams is the average size for which corrective surgery is considered. Holmium laser therapy of the prostate, also known as Holmium Laser Enucleation of the Prostate (HoLEP) has been used since 1998 at the MUHC as an alternative treatment to surgery. This is particularly valuable for patients who have particularly large prostates and risk factors that render open surgery difficult.
“Treating small to moderate size prostates by regular Transurethral Resection of the prostate (TURP) – a surgical technique that removes part of the prostate gland – is still the chosen treatment for the majority of patients," explains Dr. Mostafa Elhilali, Stephen Jarislowsky Chair of Urology at McGill University, urologist at the MUHC and lead author of the new study. “However, the most challenging aspect about the use of minimally invasive techniques is the high rate of recurrence and the need for re-treatment over time.”
The study, which looked at the durability of outcomes of HoLEP in nearly 1,000 patients over 10 years, demonstrated that complication rates are minimal and the need for further treatment, even up to a decade later, is less than 1 per cent, compared to 10-16 per cent with TURP. "Patients treated with HoLEP also have reduced pain and shorter hospital stays than those who undergo an open surgery,” explains Dr. Elhilali. “They are often able to resume normal activities within a week and have few to no sexual side effects."
The researchers point out that HoLEP is more effective at adequately treating all sizes of prostatic enlargement, whereas other laser techniques, such as Green Light Laser, is effective on small to moderate size prostates, similar but not better than TURP and lacks the same long-term durability. Green Light Laser has been used at the MUHC since 2005. The results of a study comparing Green Light Laser in different sized prostates showed it to be less effective in treating larger prostates. This study was also presented at the AUA meeting yesterday.
About this study:
The laser used was generously provided by Mr. Michal Hornstein through a gift to the Department of Urology in 1998.
Partners in research:
Hazem M. Elmansy M.D., McGill University Post doctoral fellow; Ahmed Kotb M.D., Cairo University, Egypt; Mostafa M. Elhilali M.D, Stephen Jarislowsky Chair of Urology at McGill and Urologist in chief at the MUHC.