The present study aims to evaluate the impact of bladder neck invasion of tumor regarding the effectiveness and safety of palliative Holmium laser enucleation of the prostate (HoLEP) in advanced prostate cancer (PCA) patients with severe bladder outlet obstruction.

Data of 28 patients with advanced PCA (≥ cT3) who underwent palliative HoLEP between October 2016 and March 2019 were included in this retrospective study. Preoperative, perioperative, and postoperative (1, 3 and 12 months) data of the patients were collected by reviewing their medical records. The effectiveness of palliative HoLEP was compared between patients with (group 1) and without (group 2) bladder neck invasion of tumor by evaluating the changing tendency of international prostate symptom score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) from baseline to 12 months postoperatively. Perioperative complications, postoperative hemoglobin drop, catheterization time, and duration of hospital stay were also compared to evaluate safety of the procedure.

Among the total of 28 patients, 18 (64.29%) presented bladder neck invasion of tumor. Total IPSS, QoL, Qmax, and PVR tended to improve significantly from baseline to 12 months postoperatively in both groups (p<0.05, Table 1). The improvement tendency of these variables did not significantly differ between the two groups except for PVR; PVR reduced significantly greater in group 2 (p=0.015, Table 1). Postoperative hemoglobin drop was not significantly different between the two groups (Table 2), and none of the patient received transfusion or presented severe perioperative complications. However, group 1 showed significantly longer catheterization time (p=0.024) and hospital stay (p=0.003) than group 2 (Table 2).

The study findings reveal that HoLEP effectively improves symptoms and urinary flow in advanced PCA patients, regardless of the presence of bladder neck invasion by the tumor. Despite group 2 patients presenting with a greater preoperative PVR compared to group 1, both groups experienced a reduction in postoperative PVR levels to a clinically acceptable range. Notably, group 2 demonstrated a significantly greater reduction in PVR post-surgery, possibly indicating a more pronounced relief of urinary retention associated with more severe bladder outlet obstruction resulting from bladder neck invasion. While postoperative complications were minimal in both groups, group 1 experienced longer catheterization times and hospital stays compared to group 2. These findings suggest that while HoLEP remains a viable palliative option for managing severe bladder outlet obstruction in advanced PCA patients, the presence of bladder neck invasion may influence certain aspects of postoperative recovery and treatment outcomes.

The presence of bladder neck invasion of tumor did not affect the effectiveness nor the safety of palliative HoLEP in advanced PCA patients.