Endoscopic YAG laser coagulation for early prostate cancer

摘要

Abstract: This paper describes the extended endoscopic treatment of early prostate cancer. A 'radical' TURP under ultrasound control leaves residual prostatic capsule 6 mm or less in depth. If the resected tissue includes prostatic cancer ($LS@C5% of specimen) endoscopic YAG laser coagulation of the prostatic capsule follows 10 weeks later using a power of 40-70 W. Since May 1986, 22 men are at least two years post treatment with a mean follow up of 38 months (range 25-50 months). Patients were assessed clinically, ultrasonically (US), and endoscopically with US-guided biopsies of any abnormal area and 'blind' transrectal prostatic biopsies of each lobe plus prostate specific antigen (PSA) measurements at 3/12, 6/12, one year, and yearly with a bone scan. Average age was 62.4 years (range 39-75). Mean prostatic volume fell 75%, from 31.5 mls (19-46 mls) to 8.1 mls (2.3-15). Five patients required bladder neck incision (BNI) after treatment. Two patients (9%) developed minor stress incontinence. Twelve of 15 maintained their potency. Biopsies have been positive in three and showed atypical prostatic cells in one. Two underwent further TURP and all four had 2nd laser treatments with negative biopsies subsequently. Two patients have evidence of remaining apical disease and underwent radiotherapy or hormonal therapy. All other patients have negative biopsies. The two clear failures (9%) have PSA levels above 4ng/100ml (4 $mu@g/L). 14 men (64%) have PSA levels of $LS@0.5 ng/100ml which implies the absence of significant prostatic acinar epithelial tissue. This technically straightforward, repeatable endoscopic method has resulted in 18 (82%) of 22 patients with significant volumes of disease (T0b and above) having no evidence of disease despite careful, repeated biopsy and clinical and biochemical examination over a mean follow up of 38.7 months. The results at this stage are encouraging and bear favorable comparison to other treatment options.!