Improvement of Medication-Refractory Lower Urinary Tract Symptoms After Prostate Radiation Therapy Using a Prostatic Urethral Lift System

Abstract

<h3>Purpose/Objective(s)</h3> To evaluate the success and toxicity of a nonsurgical prostatic urethral lift system in patients with lower urinary tract symptoms (LUTS) with and without prior prostate cancer radiation therapy. <h3>Materials/Methods</h3> From 2018 to 2020, thirty-eight patients underwent a nonsurgical prostatic urethral lift (PUL) procedure for LUTS refractory to alpha blocker medications. All patients had cystoscopic confirmation of lateral lobe obstruction. Nineteen patients underwent prior radiation therapy (RT) for prostate cancer completed an average of 15.3 months (range 3-28) prior to PUL procedure. Nineteen patients had no prior prostate cancer treatment. All patients were assessed with IPSS/quality of life (QOL) scores and urinary post void residual (PVR) ultrasound before and after PUL. Patients were also assessed for ability to discontinue alpha blocker medications for their LUTS and any post PUL toxicity based on CTCAE v5.0 criteria. Statistical comparisons before and after the PUL procedure were made with Wilcoxon signed rank test with <i>P</i> < 0.05 considered significant. <h3>Results</h3> All patients underwent successful placement of the PUL implants. Median follow up was 10 months (range 3-30). Median prostate volume was 45cc (range 20-85) for no-RT group and 41cc (range 24-80) for RT group. Median pre-PUL IPSS score was 17 (range 9-33) in the no-RT and 20 (range 11-34) in the RT groups. At last follow up, the average improvement in IPSS score was 9 points for all patients (95% CI 7-11, <i>P</i> < 0.001), 8 points for the RT patients (95% CI 5-12, <i>P</i> < 0.001) and 9 points for the no-RT patients (95% CI 7-12, <i>P</i> < 0.001). QOL improved by 1.1 points on average (95% CI 0.6-1.6, <i>P</i> < 0.001) for all patients, with similar improvement for both the RT (0.9, 95% CI 0.1-1.9. <i>P</i> = 0.09) and the no-RT (1.3, 95% CI 0.7-1.8, <i>P</i> < 0.001) patients. The average reduction in PVR was 93cc (95% CI 56-130, <i>P</i> < 0.001) for all patients, similar for both RT (90cc, 95% CI 42-138, <i>P</i> = 0.001) and no-RT (96cc, 95% CI 37-155, <i>P</i> < 0.001) patients. The percentage of patients able to discontinue alpha blockade at last follow-up was 68% for the RT patients and 74% for the no-RT patients. There was no grade 3 or higher GU toxicity in either group. <h3>Conclusion</h3> Use of a nonsurgical prostatic urethral lift system, results in significant improvement of LUTS after radiation therapy without complications, similar to patients without prior prostate radiation therapy.