There is a need to understand the predictors of prostatic urethral lift (PUL) durability to help physicians counsel patients and optimize outcomes. A simple logistic regression analysis was performed on a pooled dataset of 331 subjects across 5 PUL controlled studies with up to 5 years follow up. Predictors of “surgical durability” (no surgical treatment for return of symptoms) and “total durability” (no surgical or medical treatment for return of symptoms) were assessed at 1- and 5-year post-procedure. Placing ≤4 implants regardless of baseline prostate volume was associated with increased surgical retreatment within the first year. Through one year, more implants were protective of retreatment; for every incremental implant placed, surgical retreatment odds decreased an additional 41.2
BACKGROUND: Randomized controlled trials (RCTs) comparing minimally invasive surgical therapies (MISTs), such as Prostatic Urethral Lift (PUL), with tamsulosin for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are limited. METHODS : The Investigating Medication versus Prostatic Urethral Lift: Assessment and Comparison of Therapies (IMPACT) trial is a prospective, multicenter, 1-to-1 nonblinded RCT conducted in men with symptomatic BPH randomized to PUL or tamsulosin 0.4 mg daily. The primary endpoint was 3-month International Prostate Symptom Score (IPSS) change. Secondary endpoints included Quality-of-Life (QoL), sexual function, adverse events (AEs), and medicationadherence. RESULTS : 259 subjects were randomized (PUL n = 128, tamsulosin n = 131). Baseline demographics were similar between groups. PUL mean IPSS improved by 40 and 46 percent at 1 and 3 months versus 18 and 16 percent with tamsulosin (p < 0.001). QoL improved by 37 and 47 percent with PUL versus 11 and 24 percent with tamsulosin (p < 0.001). AEs were generally mild to moderate in both groups, and sexual function was preserved. Ninety-one percent of subjects self-reported medication adherence at 3 months while only 80 percent were adherent on pill counts. CONCLUSIONS : PUL produced greater symptom improvement and more favorable quality-of-life outcomes than tamsulosin at 3 months in the largest-to-date RCT of MIST versus medication for BPH.
To determine whether magnetic resonance imaging (MRI) image-guided biopsy (Targeted Bx) is accurate enough to replace the Combined Targeted Bx and systematic template 12-core transrectal ultrasound-guided prostate biopsy (Systematic Bx) in the detection of clinically significant prostate cancer (csPCA, Gleason score > 6), and if Targeted Bx alone significantly outperforms Systematic Bx. Data were collected retrospectively from all patients with MRI Prostate Image Reporting and Data System (PIRADS) level 3 and above that received a Combined Targeted Bx and Systematic Bx from 11/1/22 to 6/8/23 at Virginia Urology, a large community urology group. Patient information was entered into a database and analyzed using Chi-square and t-test. A total of 474 patients were identified. MRI results showed that 152 (32.1
PURPOSE:The safety and effectiveness of water vapor for ablation of prostate tissue was assessed in men with intermediate-risk localized prostate cancer (PCa). MATERIALS AND METHODS:A prospective, multicenter, single-arm study (VAPOR 2) was conducted in 235 men at 26 centers across the United States in men ≥ 50 years, with Gleason Grade Group 2 PCa confined to a single Prostate Imaging Reporting and Data System 3 or 4 abnormality on multiparametric MRI fusion biopsy, PSA level ≤ 15 ng/mL, and clinical stage ≤ T2c. Data presented are a predefined subset analysis of 110 men completing 12-month follow-up to assess only ablative efficacy and toxicity. Reported outcomes include biopsy 6 months post treatment PSA, prostate volume reduction, urinary/sexual function, quality-of-life questionnaires, and adverse events. The 3-year follow-up analysis will evaluate efficacy in PCa management, with 5 years of total follow-up. RESULTS:The median age was 65 years, with a median baseline PSA of 5.6 ng/mL and prostate volume of 40.7 cc. On 6-month biopsy, targeted sampling of the treated region revealed benign tissue only in 75% and benign tissue or Gleason Grade Group 1 PCa in 91%. Regression analysis did not identify a significant baseline predictor of positive biopsy. PSA showed a median reduction of 58%, with a median 8 cc reduction in prostate volume. Urinary and sexual function showed an initial decline followed by gradual recovery through 12 months. Perioperative adverse events were generally mild and resolved without sequelae, with no reports of rectal injury. CONCLUSIONS:The VAPOR 2 study demonstrated effective ablation of prostate tissue in men with localized, intermediate-risk PCa with low rates of procedural morbidity.
