Prostate Cancer Catch Rate is Higher with HoLEP than with TUR-P Surgery

Prostate cancer is detected at a higher rate with HoLEP than with TUR-P

In elderly men who have bladder outlet obstruction due to benign prostate hyperplasia, BPH, and have difficulty urinating, drug treatments are ineffective or if there are other conditions that require surgery, the only option is surgical treatment, that is, surgical removal of the prostate. For many years, transurethral resection of the prostate (TUR-P, TURP) and open prostate surgery were widely used in the surgical treatment of BPH, and in recent years, HOLEP has been widely used in the surgical treatment of benign prostate disease, especially in developed countries such as the USA and Europe.

With the HOLEP method, the benign adenoma of the prostate, which enlarges and presses on the urinary tract, is entered through the urethra without making any incisions, separated from the prostate capsule and thrown into the bladder, where it is disintegrated and taken out in small pieces. Today, the HOLEP method in the surgical treatment of BPH is accepted as an alternative to open surgery and closed TURP surgeries by the European Urology and American Urology societies.

HOLEP surgery is not a prostate cancer surgery. Prostate cancer largely develops from the outside of the prostate, whereas benign prostatic enlargement (BPH) develops from the inside of the prostate, an enlargement of the glands around the urethra. Enlarged prostate tissues around the urethra press on the urethra, that is, the urinary canal, causing urinary problems in older men. For those who will have HOLEP or TURP or open surgery due to prostate enlargement, a prostate specific antigen (PSA) test is performed to find out if they have prostate cancer before, MRI is taken depending on the situation and a biopsy is taken if necessary. If patients have prostate cancer, the surgery is different. Patients with prostate cancer undergo “radical prostatectomy” surgery (open, laparoscopic or robotic). In this surgery, the prostate is completely removed from the surrounding semen ducts and lymph nodes, including its outer capsule.

Benign prostate enlargement surgery is different from prostate cancer surgery. Here, not all prostate and semen ducts, only enlarged adenomas (glands) around the urethra that make urination difficult are removed by open or closed surgical methods. In the operation of benign prostate enlargement with the TUR-P method, not all enlarged glands can be removed and therefore these patients may require reoperation over time.

After benign prostate surgeries, all of the removed parts are sent to pathology and these tissues are examined for cancer. At the end of this examination, cancer may occur in some of the benign prostate patients. If the cancer has emerged, the necessary treatment planning is made accordingly. According to the results of a study published in a reputable medical journal on International Urology, the removed tissues of patients who underwent TURP and HOLEP surgery for BPH were pathologically examined. Prostate cancer has been identified.

The scientists who conducted the research explain the result as follows:

“Because more tissue is removed in the operation of benign prostatic enlargement with HOLEP compared to the operation with TUR-P, prostate cancer is detected at a higher rate in patients who underwent HOLEP as a result of pathological examination. This is an important advantage of HOLEP over TURP”.

Reference

HoLEP provides a higher prostate cancer detection rate compared to bipolar TURP: a matched-pair analysis. Rosenhammer B, Lausenmeyer EM, Mayr R, Burger M, Eichelberg C.World J Urol. 2018 Dec;36(12):2035-2041.

Prof. Dr. Emin ÖZBEK

Urology Specialist