Postoperative PSA And PSA Velocity Identify Presence Of Prostate Cancer After Various Surgical Interventions For Benign Prostatic Hyperplasia

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 22 Jun 2009 - 0:00 PDT

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UroToday.com - Men undergoing surgical interventions for BPH are still at risk for subsequent development of prostate cancer (CaP) due to residual tissue. It is suggested that PSA decreases approximately 0.1-0.3ng/ml for every 1g of prostate tissue removed. In the online edition of Urology, Dr. Brian Helfand and associates determined the PSA values and PSAV in patients who had undergone TURP, holmium laser resection of the prostate (HoLRP), or open prostatectomy (OP) for treatment of BPH and compare these values in patients with histologic BPH only with the values in those with incidentally found CaP.

The study was a retrospective review of 525 patients who had undergone one of these three procedures from 1992 to 2007. If incidental CaP was histologically found, patients were excluded if they underwent additional therapy as it would affect the PSA values. Only CaP patients who underwent watchful waiting were thus included. Patients on 5-alpha reductase inhibitors had their PSA values doubled and PSAV was calculated for all participants.

A total of 444 men were included in the analysis, 73.7% of whom had undergone TURP, 11.6% HoLRP and 14.7% OP. The average PSA value for all patients who underwent TURP, HoLRP, and OP was 4.3, 3.2, and 10.5ng/ml, respectively. Every patient in the OP group underwent at least one prostate biopsy compared with 20% of men in the TURP group and 12% of men in the HoLRP group. Incidental CaP was diagnosed in 8.7%, 1.9%, and 17.6% of the TURP, HoLRP, and OP patients, respectively. Additional treatment was given to 17 men in the TURP group and 4 in the OP group for their CaP. No significant differences were found between groups with regard to the mean or median preoperative PSAV of patients with or without CAP who had undergone TURP or OP. Preoperative PSA decreased by 61.9%, 31.3%, and 92.9% postoperatively after TURP, HoLRP, and OP, respectively. The mean postoperative PSAVs for the year after intervention were 0.06, 0.06, and -0.13 for TURP, HoLRP, and OP, respectively. The mean postoperative PSAV for the men with CaP who underwent TURP and OP was 0.38 and 0.47, respectively, which were significantly greater than their BPH counterpart values.

Helfand BT, Anderson CB, Fought A, Kim DY, Vyas A, McVary KT
Urology. 2009 May 8. Epub ahead of print.
doi: 10.1016/j.urology.2008.10.062

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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