The effects of 5α-reductase inhibition on benign prostatic hyperplasia treated by photoselective vaporization prostatectomy with the 120 Watt GreenLight HPS laser system.

Abstract

We sought to determine whether the efficacy and efficiency of 120W GreenLight HPS (American Medical Systems, Inc) laser photoselective vaporization prostatectomy (PVP) is compromised in patients on chronic 5α-reductase inhibitor (RI) therapy. Our GreenLight HPS laser PVP experience in patients with and without long-term 5αRI was evaluated. American Urological Association Symptom Score (AUASS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual (PVR) were measured preoperatively and at 1 and 4 weeks and at 3, 6, 12, 18, and 24 months postsurgery. PSA values and transrectal ultrasonography (TRUS) prostate volumes were determined preoperatively and at 3 months postsurgery. Fifty-seven patients were on either dutasteride or finasteride (5αRI+) and 124 were not (5αRI-). Mean prostate volumes were 67.1 ± 35.3 mL and 69.2 ± 41.9 mL (p = 0.646) and mean PSA values were 2.2 ± 2.4 ng/mL and 2.7 ± 2.6 ng/ml (p = 0.289), respectively. There were no significant differences in the parameters of laser use (13.6 ± 9.2 minutes and 13.4 ± 10.4 minutes, p = 0.965) and energy usage (87.1 ± 62.4 kJ and 91.8 ± 69.6 kJ, p = 0.623). The majority of patients were catheter-free at discharge for this wholly outpatient procedure. AUASS, QoL, and Qmax values showed significant improvement within each group (p < 0.05). Compared with baseline, PVR values improved in both groups but did not decrease significantly in 5αRI+ (p > 0.05). There was no significant difference in the degree of improvement between the 2 groups in all parameters (AUASS, QoL, Qmax, PVR, PSA, and TRUS volume). The efficacy and efficiency of PVP with the GreenLight HPS laser are not negatively affected in patients on chronic 5αRI therapy.