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Should very low-risk prostate cancer on active surveillance be considered a contraindication to anatomical enucleation? This patient had a >100 cc prostate with severe LUTS and bladder outlet obstruction, and a clear desire to be free from his urinary symptoms and improve his quality of life. We proceeded with...

10,924 views • 2 months ago •via X (Twitter)

13 Comments

Dr. Cleybismar Begot's profile picture
Dr. Cleybismar Begot2 months ago

Great question. In my opinion these patients are great candidates to anatomical enucleation in selected cases of confined disease. I frequently deal post-TURP obstruction in cases with “funnel approach” .

Nathan L. Colon MD's profile picture
Nathan L. Colon MD2 months ago

Extensive counseling/shared decision making key here. Radical prostatectomy likely over treatment and carries higher morbidity. My practice is to treat BPH/LUTS and monitor prostate cancer. I like robotic simple prostatectomy first line but any size appropriate procedure would be reasonable. I favor xrt if upstaged to clinically significant cancer but full spectrum of treatment options reviewed.

DR CARVAJAL's profile picture
DR CARVAJAL2 months ago

Totally agree

Thanasis Apostolidis's profile picture
Thanasis Apostolidis2 months ago

How old was the patient?

DR CARVAJAL's profile picture
DR CARVAJAL2 months ago

57yo

Balaji Kalyanaraman's profile picture
Balaji Kalyanaraman2 months ago

Not at all. I am routinely offering HoLEP to older (70 and above) patients with low/very low risk prostate cancer and bothersome LUTS.

Sonia Madrid's profile picture
Sonia Madrid2 months ago

En mi opinión no es una contraindicacion. Ya hay evidencia al respecto, de que tiene beneficios en cuanto a la micción, sin que afecte el progreso de cáncer de próstata

Anand Badri, MD, FACS's profile picture
Anand Badri, MD, FACS2 months ago

Not at all a contraindication I routinely disaggregate BPH from lower risk prostate cancer. No reason to have the patient suffer urinary symptoms in this setting. Offer a BPH surgery and continue surveillance afterwards.

DR CARVAJAL's profile picture
DR CARVAJAL2 months ago

Totally agree

Rodrigo Juaneda's profile picture
Rodrigo Juaneda2 months ago

Very nice surgery! I agree doing enucleation and AS.

Elio Sánchez-Ali's profile picture
Elio Sánchez-Ali2 months ago

I support you, that’s what I should do.

崔家倫 Dr Alan Chui Ka Lun's profile picture
崔家倫 Dr Alan Chui Ka Lun2 months ago

agrees, very low risk one is not "cancer" anyway, with bothersome symptoms, proceed to HoLEP

Mohamed El Komy's profile picture
Mohamed El Komy2 months ago

This is art sir

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