Third patient case study
We asked three urologists how they would counsel and discuss treatment options with three different men, all of whom have symptomatic prostate enlargement. The three urologists we invited to share their opinions on how to manage the three cases all have a special interest in the treatment of male LUTS and have been instrumental in the introduction of techniques that provide alternatives to monopolar and bipolar transurethral resection. In their own practice few men choose TURP. Whilst three of them offer a number of different treatment options, they don’t offer all available therapies for BPE/BPH, this may mean that treatment options with which they are less personally familiar are not discussed in great depth.
When considering each case, we asked them to think about the following factors:
- Describe how you would most likely treat the patient (in accordance with your local practise, or in consideration to any clinical guidelines)
- Highlight the key elements of the discussion you would have with the patient in order to determine his outcome priorities and risk tolerance
- Finally, could you recommend which technology (based on your own practise) you would offer to the patient and why this offers benefits to the patient.
A 68-year-old man’s prostate size is estimated at 80g after digital rectal examination (DRE). This patient has a PSA of 3.0 ng/ml. His IPSS score is 21. He is sexually active and has no other significant comorbidity.
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Richard Hindley was an early adopter of GreenLight Laser Vaporization of the prostate and has performed over 1000 procedures. He performs both classic PVP and Anatomical Vaporization and is happy to treat gland volumes up to 150mls. He also offers Urolift® and was the first UK surgeon to perform Rezum in 2017 and has already performed over 500 procedures. For the small proportion of men with very large glands requiring enucleation he will refer on to an expert colleague. He publishes widely on BPH and prostate cancer diagnostics and focal therapy. He is an advocate for patient choice in the treatment of male LUTS.
Vincent Misrai is a pioneer of anatomical enucleation of the prostate using GreenLight laser, having performed more than 1000 procedures. In his practice he also offers aquablation. Academically he publishes on BPH topics, with special attention to outcomes and learning curve assessments of each technology.
Tev Aho developed the Holmium Laser Enucleation of the Prostate service in Cambridge, UK after training with Peter Gilling and Mark Fraundorfer in New Zealand. He has treated more than 2,000 men with this modality, he also offers Urolift and will begin to offer Rezum. He has done 10 aquablation cases as part of the first randomized study (WATER study). Academically he publishes widely on Anatomical Endoscopic Enucleation of the Prostate (AEEP), believing firmly that “enucleation is enucleation is enucleation”. He is a pioneer in approaching patient choice in treatment of male LUTS.
AEEP – Anatomical Endoscopic Enucleation of the Prostate
AF – Atrial Fibrillation
OSP – Open Simple Prostatectomy
PAE – Prostate Artery Embolization
PVP – Photoselective Vaporization of the
Prostate - standard GreenLight XPS vaporization of the prostate
TURP – Transurethral Resection of the Prostate
PSA – Prostate-Specific Antigen
LUTS – Lower Urinary Tract Symptoms
MIT – Minimally Invasive Therapy
TRUS – Transrectal Ultrasound