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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... show more
10,924 görüntüleme • 2 ay önce •via X (Twitter)
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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” .

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.

Totally agree

How old was the patient?

57yo

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

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

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.

Totally agree

Very nice surgery! I agree doing enucleation and AS.

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

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

This is art sir
