Background/Objectives: Laser ablation is a promising technique for tissue-debulking in patients with symptomatic benign prostatic hyperplasia (BPH). This study evaluated the effects of focused laser ablation of the prostate (FLA) on urinary symptoms for patients with BPH. Methods: Since 2018, 62 patients had bilateral prostate FLA for prostate cancer and/or symptomatic BPH, defined as an international prostate symptom score (IPSS) ≥11, and have 6-month follow-up data. Urinary and sexual health were scored with standardized surveys while imaging defined prostate anatomy. FLA was performed as an outpatient procedure with either transrectal MRI-guided (n= 24) or transperineal ultrasound-guided (n= 38) laser fiber placement to debulk the prostate and/or ablate cancer foci plus margins. Enhanced prostate MRI was performed immediately or up to 2 days later to assess the treatment zones. Follow-up then consisted of PSA levels every 6 months and MRI at 6–12 months and then yearly combined with patient sexual/urinary surveys and clinical assessments. Results: All patients had technically successful FLA and 6-month clinical and imaging follow-up. At 6-month follow-up, mean IPSS was reduced by 43% relative to baseline (10.4 vs. 18.4), mean prostate volume was reduced by 30% (42.2 vs. 60.5 mL), and mean PSA was reduced by 58% (4.3 vs. 10.2 ng/mL). All of these changes were statistically significant (p≤ 0.008). Compared with baseline, there was no significant change in the SHIM score at 6 months (16.0 vs. 16.8;p= 0.59). In a subset of patients for whom 12-month data were available, there were significant reductions in PSA (61%; 4.1 vs. 10.5 ng/mL;p< 0.002) and IPSS (45%; 9.9 vs. 17.9;p< 0.002), while the 12-month SHIM score was not significantly different from baseline (15.2 vs. 16.0;p= 0.27). Mean laser irradiation time was 19 min with a mean energy deposition of 13,562 J. The most frequent adverse events were prolonged urinary catheterization in 10 patients (16%) and urinary tract infection in 8 (13%). Conclusions: FLA is a safe and effective tissue-debulking technique for patients with symptomatic BPH. This outpatient procedure requires minimal procedure time and can be performed without the need for operating rooms or cystoscopy. Our results are consistent with those of previous studies indicating that FLA preserves sexual function.
背景/目的：激光消融术是治疗有症状良性前列腺增生（BPH）患者组织减容的一种前景广阔的技术。本研究评估了聚焦激光前列腺消融术（FLA）对BPH患者泌尿系统症状的影响。方法：自2018年起，62名患者因前列腺癌和/或有症状BPH（定义为国际前列腺症状评分[IPSS]≥11分）接受了双侧前列腺FLA治疗，并拥有6个月随访数据。通过标准化问卷评估泌尿及性健康状况，同时通过影像学明确前列腺解剖结构。FLA作为门诊手术实施，采用经直肠MRI引导（24例）或经会阴超声引导（38例）方式置入激光光纤，以减容前列腺和/或消融癌灶及边缘。术后立即或两天内进行增强前列腺MRI以评估治疗区域。随访内容包括每6个月检测PSA水平，6-12个月及之后每年进行MRI检查，并结合患者性功能/泌尿系统问卷及临床评估。结果：所有患者均技术成功完成FLA，并获得6个月临床及影像学随访。6个月随访时，平均IPSS较基线降低43%（10.4分 vs. 18.4分），平均前列腺体积减少30%（42.2 mL vs. 60.5 mL），平均PSA降低58%（4.3 ng/mL vs. 10.2 ng/mL）。所有变化均具有统计学显著性（p≤0.008）。与基线相比，6个月时SHIM评分无显著变化（16.0分 vs. 16.8分；p=0.59）。在可获得12个月数据的患者亚组中，PSA（61%；4.1 ng/mL vs. 10.5 ng/mL；p<0.002）和IPSS（45%；9.9分 vs. 17.9分；p<0.002）均显著降低，而12个月SHIM评分与基线无显著差异（15.2分 vs. 16.0分；p=0.27）。平均激光照射时间为19分钟，平均能量沉积为13,562焦耳。最常见的不良事件为10例患者（16%）需延长导尿时间，8例患者（13%）发生尿路感染。结论：对于有症状的BPH患者，FLA是一种安全有效的组织减容技术。该门诊手术耗时短，无需手术室或膀胱镜检查即可实施。我们的研究结果与既往研究一致，表明FLA能够保护性功能。
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