Robotic Waterjet Resection for Men With Prostate Cancer Suffering From Lower Urinary Tract Symptoms.

OBJECTIVE

To evaluate the impact of Aquablation on circulating tumor cells (CTCs) in men with localized prostate cancer.

METHODS

This prospective study included subjects with biopsy-positive mpMRI visible lesions (PIRADS ≥3) who underwent Aquablation. Ten mL blood samples were collected before, during and after the procedure to measure CTC counts using an immunofluorescence assay.

RESULTS

The mean age of participants was 63.4 years, with a baseline PSA of 8.9 ng/mL and a prostate volume of 60.3 mL. All subjects experienced reduced IPSS scores and stable or improved SHIM and MSHQ-EjD scores. Detectable CTCs were found in 80% of subjects before Aquablation, 100% immediately after Aquablation, 20% on post-op day 2, and 60% on post-op day 7. The mean number of CTCs per patient 10 mL blood draw was 1.2 preoperatively, 3.2 immediately post-op, 0.2 on day 2, and 1.0 on day 7. Prostate volumes decreased significantly at 3 and 6 months, with corresponding reductions in PSA levels. There were no adverse events reported. Specifically, no instances of incontinence, erectile dysfunction, ejaculatory dysfunction, or rectal toxicity were observed. At 6-month follow-up, all baseline mpMRI lesions were no longer visible on mpMRI and follow-up biopsies showed no grade group progression.

CONCLUSION

In an active surveillance population, Aquablation resulted in improved urinary function, stable or improved sexual function, and a transient spike in CTCs lasting <2 days that did not result in any oncologic concern. Aquablation may be considered a safe option for men with localized prostate cancer who require treatment for LUTS due to BPH.