Evidence for Combining Prostatic Urethral Lift With Radiotherapy

In this installment, Daniel Welchons, MD, reviews the CLEAR trial, a head-to-head comparison of prostatic urethral lift (PUL, UroLift) and Rezūm water vapor therapy that measured catheter independence 3 to 7 days after the procedure. Among approximately 80 patients, 41 of 42 PUL patients were catheter-independent within that window compared with 27 of 37 Rezūm patients, reinforcing the faster recovery he says makes the lift more compatible with staying on a radiation timeline.

Aurelie Garant, MD, then details her study, presented at ASTRO 2025, in which 15 men with clinically significant prostate cancer and International Prostate Symptom Scores (IPSS) of 17 or higher underwent fiducial marker placement, hyaluronic acid spacer insertion, and PUL in a single session under general anesthesia, followed a month later by 5-fraction SAbR. Approximately half of patients experienced low-grade adverse events, most commonly minor bleeding from the urethra managed with a brief Foley catheter, with no high-grade serious adverse events and no major radiotherapy-related toxicity in the first 90 days. Welchons calls the approach a practical way to streamline care for well-selected patients.

Garant adds that median IPSS scores improved from 21 at enrollment to 14 by the time of simulation, with a brief uptick after SAbR before returning to about 14 at 3 months, alongside continued improvement on EPIC-26 urinary scores, a signal she found notable given SAbR typically worsens urinary symptoms initially. Welchons frames the findings as a shift in mindset toward optimizing patients before radiation rather than managing complications afterward, calling post-radiation urinary surgery high-risk and something he strongly prefers to avoid. Garant notes that more urologists are now training in both procedures, easing access to this combined approach.

In the next episode, "Referral Pathways and Practical Takeaways for Prostate Radiotherapy," Garant and Welchons close out the discussion by covering which patients are the right candidates for combining procedures, what research is still needed, and the one change they want colleagues to make.