How holmium laser enucleation of the prostate reduces bladder radiation in prostate cancer radiotherapy

Authors

  • Denzel Zhu University of Rochester Medical Center
  • Wesley Rivais University of Rochester Medical Center
  • Daniel Huang University of Rochester Medical Center
  • Terris Igwe University of Rochester Medical Center
  • Amoateng Emmanuel University of Rochester Medical Center
  • Carl Ceraolo University of Rochester Medical Center
  • Nitin Sharma University of Rochester Medical Center
  • Rajat Jain University of Rochester Medical Center
  • Edward M. Messing University of Rochester Medical Center
  • Hong Zhang University of Rochester Medical Center
  • Scott O. Quarrier University of Rochester Medical Center

DOI:

https://doi.org/10.5489/cuaj.9730

Keywords:

prostate cancer, HoLEP, radiotherapy, off target radiation, bladder radiation

Abstract

Introduction: Off-target delivery of radiotherapy to the bladder and rectum is a major source of morbidity from radiotherapy (RT) for the treatment of prostate cancer (PCa). Holmium laser enucleation of the prostate (HoLEP) has the ability to dramatically reduce prostate volume among men with benign prostatic hyperplasia (BPH). We sought to determine if the prostate volume reduction among men with BPH would result in a reduction in off-target radiotherapy delivery to the bladder and rectum during RT for PCa.

Methods: We performed a retrospective study among men who underwent HoLEP from 2015−2025 at our institution for BPH with a prostate volume >80 mL and who had both incidentally obtained preoperative and postoperative computed tomography (CT) of the pelvis. A hypothetical external beam radiation therapy (EBRT) prostate plan (70 Gy in 28 fractions) was performed on the pre- and post-HoLEP CT. Outcomes included the volume of bladder and rectum exposed to radiation.

Results: A total of 176 men underwent HoLEP with a preoperative CT from 2015−2025, of whom, 11 met study criteria. The median volume of bladder exposed to 70 Grey decreased after HoLEP from 26.1 cc to 15.9 cc (p=0.004); median volumes for rectum exposed to radiation did not change significantly.

Conclusions: HoLEP dramatically reduces off-target radiation dose to the bladder, but not to the rectum during PCa RT. Performing HoLEP prior to PCa RT radiotherapy may provide benefits in limiting bladder-related RT toxicity.

Downloads

Download data is not yet available.

Downloads

Published

2026-09-25

How to Cite

Zhu, D., Rivais, W., Huang, D., Igwe, T., Emmanuel, A., Ceraolo, C., … Quarrier, S. O. (2026). How holmium laser enucleation of the prostate reduces bladder radiation in prostate cancer radiotherapy. Canadian Urological Association Journal, 21(1). https://doi.org/10.5489/cuaj.9730

Issue

Vol. 21 No. 1 (2027): CUAJ January

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.