Robotic Waterjet Resection for Men with Prostate Cancer Suffering from Lower Urinary Tract Symptoms.

Objectives: 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, 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 pre-operatively, 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.

Conclusions: 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.