? I) Benign Prostatic Hyperplasia (BPH)
1️⃣ Minimally Invasive Surgical Therapies (MIST)
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UroLift System (Prostatic Urethral Lift)
- Mechanical retraction of lateral lobes (no tissue removal)
- Office procedure, preserves ejaculation
- Best for prostates <80 cc, no obstructive median lobe (relative)
Trend: Expanding indications with better patient selection.
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Rezūm System (Water Vapor Thermal Therapy)
- Convective RF water vapor → tissue necrosis
- Preserves sexual function
- Suitable for median lobe enlargement
Trend: Long-term data (>5 yrs) support durability.
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- Robotic, image-guided waterjet resection
- Reproducible, size-independent
- Low ejaculatory dysfunction rate
New angle: Increasing use for large glands (80–150 cc).
2️⃣ Laser Innovations
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Thulium Fiber Laser (TFL)
- Better hemostasis vs monopolar TURP
- Enucleation (ThuLEP) gaining ground
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Holmium Laser Enucleation of the Prostate
- Size-independent gold standard alternative to open surgery
- Same-day discharge possible
Trend: Shift from TURP → enucleation techniques.
3️⃣ Emerging Concepts
- Day-case prostate surgery
- AI-based bladder outlet obstruction assessment
- MRI-based prostate volume planning
? II) Prostate Cancer
1️⃣ Imaging Revolution
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- Superior staging vs conventional CT + bone scan
- Detects micrometastasis
- Changes management in high-risk & biochemical recurrence
Paradigm shift: Now standard in many guidelines for high-risk staging.
2️⃣ Focal Therapy (Organ-Preserving)
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High-Intensity Focused Ultrasound
- MRI-targeted ablation
- For low/intermediate-risk localized disease
? Irreversible Electroporation (IRE – “NanoKnife”)
- Non-thermal ablation
- Nerve-sparing potential
Trend: Bridging active surveillance and radical therapy.
3️⃣ Robotic Surgery Evolution
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Retzius-sparing robotic prostatectomy
- Posterior approach
- Faster continence recovery
? Single-port robotic platforms
- Less invasive access
- Cosmesis improvement
4️⃣ Systemic Therapy Advances (mHSPC & mCRPC)
? Triplet Therapy (ADT + Docetaxel + ARSI)
- Improved OS in high-volume disease
? Next-Gen AR Inhibitors:
5️⃣ Radioligand Therapy
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- Targets PSMA-expressing cells
- Used in metastatic CRPC
- Improves OS & PFS
Major shift: Precision oncology in advanced prostate cancer.