Lower urinary tract symptoms (LUTS) secondary to Benign Prostatic Hyperplasia (BPH) amongst men with localised prostate cancer (PC) are common. For those with localised medium to high-risk PC undergoing radiotherapy, surgical intervention for symptomatic BPH may increase the risk of significant genitourinary toxicity. Evidence has shown transurethral prostatic resection (TURP) before or after brachytherapy, hypofractionated and external beam radiotherapy is associated with increased risk of urinary incontinence, retention and genitourinary (GU) toxicity. However, the development of novel surgical interventions for BPH may offer lower risk of genitourinary toxicity and other benefits.

PubMed, Medline (Ovid), EMBASE and Cochrane Library were searched. Articles exploring: Holmium laser enucleation (HoLEP), laser photo-vaporization (PVP/Greenlight laser), Rezum water vapor therapy and Urolift were included. A total of 64 articles were identified. 7 articles were included in the final analysis.

Three studies reported on PVP (n=3), while two studies examined HoLEP (n=2) and Urolift (n=2). IPSS was the most measured outcome, with all studies displaying an improvement in median IPSS. This was consistent regardless of radiotherapy occurring before or after intervention. Uroflow was also examined, with studies assessing HoLEP and PVP revealing an improvement in peak flow rate, average flow and post void residual. Complications following novel interventions for BPH were rare, catheter free rates were high and the number of additional procedures following intervention were insignificant compared to conventional TURP. PVP was non-inferior to TURP in terms of genitourinary toxicity. Urolift concurrent with the insertion of fiducial markers was also found to reduce any delay to radiotherapy and potentially obviate the need for an additional surgical procedure.

While the genitourinary risks of conventional TURP amongst this population have been clearly highlighted in the literature, our results suggest novel surgical therapies for BPH may result in less genitourinary toxicity and improved genitourinary outcomes amongst this at-risk population.