Prostate specific antigen measurements after minimally invasive surgery of the prostate in men with benign prostatic hypertrophy

There is a trend of minimally invasive surgery in the treatment of benign prostatic hypertrophy (BPH). Studies have examined levels of prostate specific antigen (PSA) in patients after open prostatectomy or transurethral resection of prostate (TURP) and noted reset of PSA to lower values after surgery. We reviewed PSA levels in patients after minimally invasive procedures to determine if levels were reset. There were 120 patients (age 45-70) enrolled in the study. Fifty patients underwent laser ablation, 20 patients had electrovaporization (TVP) and 50 patients underwent TURF. PSA measurements were obtained prior to and after surgical procedures in a three-year follow-up. Mean pre-operative PSA was 2.8 (+/- 0.34) ng/ml for laser cohort, 3.2 (+/- 0.31) ng/ml for the TURF group and 2.3 (+/- 0.42) ng/ml for TVP patients (P = 0.33). At 1 y follow-up, mean PSA decreased 32% for laser patients, 46% for the TURF cohort and 8% for TVP group. The largest mean decrease in PSA velocity was - 1.5 (+/- 0.31) ng/ml per y for TUFF followed by 0.9 (+/- 0.29) ng/ml per y for laser patients and - 0.1 (s.d. +/- 1.2) ng/ml per y for TVP group in y 1. The TURF group maintained the largest decrease in PSA velocity in y 5 - 0.6 (+/- 0.26) ng/ml per y. Three patients (2-TURP, 1-TVP) were diagnosed with prostate cancer during follow-up. In conclusion, serum PSA levels were reset at lower levels following different surgical interventions. This lower level of PSA remained decreased for 2 y postprocedure. Urologists should be cognizant of this reset level and monitor PSA levels for possible increases to screen for prostate cancer in this patient population.