Does radiotherapy after prostate enucleation with thulium fiber laser worsen functional outcomes: A mid-term retrospective analysis?

[BACKGROUND] Thulium fiber laser enucleation of the prostate (ThuFLEP) is a minimally invasive treatment for benign prostatic hyperplasia (BPH). Some patients undergoing ThuFLEP are later treated with external beam radiation therapy (EBRT) for incidental or preexisting prostate cancer. However, the impact of prior ThuFLEP on genitourinary toxicity following EBRT remains unclear.

[METHODS] We conducted a retrospective study including all patients who underwent EBRT following ThuFLEP for prostate cancer in a single center between March 2021 and July 2024. Functional outcomes were assessed using IPSS and IPSS-QoL scores at three time points: pre-surgery, pre-EBRT, and post-EBRT. Incontinence and genitourinary complications were also recorded during the follow-up using the CTCAE scale. Statistical analysis included paired t-tests or Wilcoxon tests for continuous variables and Chi tests for categorical variables.

[RESULTS] Among 312 patients who underwent ThuFLEP, 13 (4.2%) subsequently received EBRT for prostate cancer. The mean (SD) age of the population was 86.2years (38.1), and the median (IQR) follow-up was 18.5 (17.4-22.4). Most had a preoperative diagnosis (76.9%) and were treated with either stereotactic body radiotherapy (61.5%) or moderate hypofractionation (38.5%). IPSS significantly improved after ThuFLEP (16.3±6.9 to 10.3±7.4, P=0.01) and remained stable after EBRT (10.3±7.4 to 8.7±8.2, P=0.08). Similarly, QoL scores improved post-surgery and were not significantly altered by EBRT. Urinary incontinence was observed in 3 patients after surgery and in 4 after EBRT, including one case of de novo urge incontinence. Acute genitourinary toxicity was low grade (1-2) and mainly frequency (grade 1, n=6, 46.2%) and urgency (grade 1, n=2, 15.4% and grade 2, n=1, 7.7%).

[CONCLUSION] EBRT following ThuFLEP appears feasible and generally well tolerated, with no significant deterioration in urinary symptoms and with low genitourinary toxicity. These findings support the feasibility of combining ThuFLEP and EBRT in selected patients with prostate cancer. Larger prospective studies with extended follow-up are needed to confirm these preliminary results.