Feasibility of simultaneous photoselective vaporization of the prostate and MRI/TRUS fusion guided biopsy in patients with suspected prostate cancer
Authors: Zhang Zhihua , Chang Taihao , Ma Shenfei , Wang Yashen , Luo Fei , Li Jian 
Published: March 2024

Objective
To investigate the feasibility of simultaneous MRI/TRUS fusion-guided prostate biopsy and transurethral laser vaporization of prostate in frail elderly patients with bladder outlet obstruction and suspected prostate cancer.
Methods
Elderly patients with suspected prostate cancer with lower urinary tract obstruction admitted to the Department of Urology of Tianjin Union Medical Center from January 2019 to December 2022 were collected. During the same period, MRI/TRUS fusion-guided prostate biopsy and photoselective vaporization of the prostate (PVP) were performed, and clinical information of the patients was collected. This included patient's age, American Society of Anesthesiologists (ASA) score, body mass index (BMI, kg/m2), total prostate-specific antigen (PSA, ng/ mL), free prostate-specific antigen (FPSA, ng/ mL), FPSA/TPSA %, prostate volume (PV, mL), PSA density (PSAD), PI-RADS score, postvoid residual urine volume (PVR, mL), urodynamic test maximum detrusor pressure (Pdet max), maximum urine flow rate (Qmax, mL/s), International Prostate Symptom Score (IPSS), Quality of Life score (QoL), comorbidities, and presentation status of the World Health Organization (WHO)/Oriental Joint Oncology Group (ECOG).
Result
Clinical data of 48 patients: Age 61–92 years old (76.4 ± 7.5), BMI 20.281–36.364 (27.012 ± 4.215) kg/m2, with one or more comorbiditis (diabetes, hypertension, coronary heart disease, cerebral infarction, etc.) and oral treatment with related drugs, TPSA 0.509-156 (26.773 ± 26.959) ng/mL, PSAD 0.01–2.84 (0.435 ± 0.511), IPSS 26–35 (32.021 ± 2.862), QOL 4–6 (5.250 ± 0.601), TPSA 0.09–156 (26.773 ± 26.959) ng/mL, PSAD 0.01–2.84 (0.435 ± 0.511), IPSS 26–35 (32.021 ± 2.862), and QOL 4–6 (5.250 ± 0.601). The residual urine volume of the bladder was 90-1200 (379.958 ± 241.003) mL, the maximum detrusor pressure was 20.0–90.0 (55.458 ± 16.854) cmH2O, and the maximum urine flow rate (Qmax) was 0–10.0 (4.542 ± 2.379) mL/s. ECOG score 1–4 (2.708 ± 0.824), G8 score 5–18 (13.250 ± 3.380). The operation time was 43–107 (75.0 ± 16.7) min, the intraoperative bleeding was 50–99(72.1 ± 17.1) mL, and there was no blood transfusion. Forty-three patients with postoperative pathological findings of prostate acinous adenocarcinoma returned to the hospital for blood PSA examination at 3 months, 6 months and 12 months, respectively. Reviewing the clinical data of the 48 enrolled patients, due to the advantages of PVP surgery compared with traditional transurethral resection of prostate (TURP), such as less bleeding and faster recovery, prostate puncture biopsy and PVP surgery at the same time did not significantly increase the operative time and blood loss of patients. The IPSS score, QOL score, TPSA and PRV levels of patients at 3 months, 6 months and 12 months after surgery were significantly decreased, while the Qmax level was significantly increased.
Conclusion
Simultaneous prostate puncture biopsy and PVP surgery can quickly and significantly improve the symptoms of lower urinary tract obstruction in elderly patients with prostate cancer while clarifying the pathologic nature of the patient. After the corresponding postoperative adjuvant treatment, the quality of life and survival rate with tumor can be improved. Simultaneous prostate puncture biopsy and PVP surgery can be performed. It is safe, effective and feasible for the elderly patients with prostate cancer who have completed urodynamic examination and are not suitable for radical treatment.