UROLOGY/LASER TREATMENT : Study calls holmium laser therapy 'the new gold standard' for enlarged prostate treatment

Based on the results of the longest comprehensive assessment to date of holmium laser therapy (www.mcgill.ca/tcpsych/channels/news/174421), researchers suggest that the biophotonic technology may now be safely considered the new gold standard for treating benign prostatic hyperplasia (BPH), which affects most men as they age. The research team, from the McGill University Health Centre (MUHC), presented findings demonstrating short- and long-term benefit of the laser treatment during the 2011 Annual Meeting of the American Urology Association.

BPH can cause urination and bladder problems; corrective surgery has been the typical treatment. But the team at MUHC has used holmium laser therapy of the prostate, also known as Holmium Laser Enucleation of the Prostate (HoLEP), since 1998 as an alternative. “Treating small- to moderate-size prostates by regular transurethral resection of the prostate (TURP)—a surgical technique that removes part of the prostate gland—is still the chosen treatment for the majority of patients,” explains Dr. Mostafa Elhilali, Stephen Jarislowsky Chair of Urology at McGill University and urologist at the MUHC, adding that the approach is plagued by high rates of recurrence and the need for re-treatment.

The study followed nearly 1,000 patients for 10 years; findings showed that with HoLEP complication rates were minimal and implied less need for further treatment (<1%) than TURP (10–16%), even up to a decade later. “Patients treated with HoLEP also have reduced pain and shorter hospital stays than those who undergo an open surgery,” said Dr. Elhilali. “They are often able to resume normal activities within a week and have few to no sexual side effects.”

In addition, the researchers say HoLEP is effective in treating all sizes of prostatic enlargement. Other laser techniques, such as therapy using the GreenLight laser (American Medical Systems, Minnetonka, MN), are effective only for minimal to moderate prostate enlargement—and are not better than TURP. Researchers at MUHC have tested and used the GreenLight Laser since 2005; another of their studies showed it to be less effective in treating larger prostates.