FUNCTIONAL OUTCOMES FOLLOWING EXTERNAL BEAM RADIATION THERAPY FOR PATIENTS WITH PRIOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE

Purpose: Holmium laser enucleation of the prostate (HoLEP) is an increasingly utilized technique for treating male voiding dysfunction due to benign prostatic hypertrophy. Some HoLEP patients with prostate cancer may opt for external beam radiation therapy (EBRT) as a definitive treatment. Little is known about the safety and functional impact of EBRT post-HoLEP. This study evaluates patient-reported voiding outcomes after EBRT following HoLEP, focusing on incontinence-related outcomes.

Methodology: We obtained institutional review board approval for this retrospective and cross-sectional study. We identified HoLEP patients who subsequently underwent EBRT and collected data retrospectively over four years (2019-2023) from a single surgeon's HoLEP cohort. Data included patient demographics, prostate cancer/radiation therapy details, and baseline voiding symptoms. We collected current functional voiding outcomes via phone calls or portal communication including the International Prostate Symptom Score (IPSS) quality of life score and the Michigan Incontinence Symptom Index (M-ISI). Adverse events during follow-up were documented.

Results: 24 patients were identified who received EBRT for prostate cancer post-HoLEP. Demographic details and prostate cancer/radiation therapy characteristics are listed in Table 1. Median QoL following radiation was 1 (range 0-6), median M-ISI Severity Score was 4 out of 32 (range 0-17), and median M-ISI Bother Score was 0 out of 8 (range 0-4). IPSS scores and M-ISI severity/bother scores are listed in Table 2. One patient experienced bladder neck contracture (BNC) approximately one year after radiation (18 months after HoLEP), causing bothersome incontinence and LUTS. He was offered balloon dilation but opted to have a salvage prostatectomy at an outside institution.

Conclusions: In our patient cohort, most individuals who received EBRT after HoLEP reported a high quality of life related to urinary symptoms and a low incidence of urinary incontinence. However, one patient suffered BNC, a known adverse event post-EBRT. Due to our limited sample size, it remains uncertain whether the risk of BNC is higher in patients with prior HoLEP. Larger-scale studies should investigate the incidence of bladder neck contracture in patients receiving EBRT after HoLEP.

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