Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate

Po-You Chen; Shao-Ming Chen; Horng-Heng Juang; Chen-Pang Hou; Yu-Hsiang Lin; Pei-Shan Yang; Chien-Lun Chen; Phei-Lang Chang; Kuo-Yen Lin; Ke-Hung Tsui

doi:10.3389/fmed.2021.783221

Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate

Front Med (Lausanne). 2022 Jan 3:8:783221. doi: 10.3389/fmed.2021.783221. eCollection 2021.

Authors

Po-You Chen¹, Shao-Ming Chen², Horng-Heng Juang^{1

3}, Chen-Pang Hou^{1

4}, Yu-Hsiang Lin^{1

3}, Pei-Shan Yang^{1

2}, Chien-Lun Chen¹, Phei-Lang Chang¹, Kuo-Yen Lin¹, Ke-Hung Tsui^{1

5

6}

Affiliations

¹ Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Department of Urology, Heping Campus, Taipei City Hospital, Taipei, Taiwan.
³ Department of Anatomy, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴ Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan.
⁶ TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.

Abstract

Background: We determined the effect of prostate-specific antigen velocity (PSAV) on the surgical outcome of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia (BPH). Methods: A retrospective review was performed of prospectively collected data of patients with BPH who underwent ThuLEP at any time from 2017 to 2019. Patients who had undergone BPH surgery or had prostate cancer previously were excluded, and patients with prostate-specific antigen (PSA) > 4 ng/ml were examined through transrectal ultrasound-guided prostate biopsy to rule out prostatic malignancy. Furthermore, patients were excluded if prostatic malignancy was diagnosed during postsurgery follow-up. Results: The PSA level, International Prostate Symptom Score (IPSS), and quality of life (QoL) of 27 male patients at 3 and 15 months postsurgery differed significantly from those at presurgery; the maximum flow rate (Qmax) and postvoid residual (PVR) significantly differed between 3 months postsurgery and presurgery; and 22 and 5 patients had good to excellent and fair to poor outcomes, respectively, at 15 months postsurgery. Patients were divided into two groups (fair and poor vs. good and excellent outcomes at 15 months postsurgery), which significantly differed with respect to PSAV at 3 months postsurgery (P = 0.04), IPSS presurgery (P < 0.02), surgical length (P = 0.01), and hospitalization duration (P = 0.04). In a receiver operating characteristic (ROC) analysis, the optimal cutoff value of PSAV of -0.52 ng/ml characterized effectiveness at 15 months after ThuLEP, and the area under the curve (AUC), sensitivity, and specificity were 0.82 (P < 0.02), 0.80, and 0.82, respectively. For PSAV < -0.52 and ≥-0.52 ng/ml, the percentages of reduction for IPSS, QoL, Qmax, and PVR were -78.6 and -71.4%, -33.3 and 0.0%, 94.4 and 40.0%, and -85.1 and -38.7%, respectively. Conclusions: Postsurgical PSAV was positively correlated with surgical success, and the PSAV cutoff was -0.52 ng/ml. PSAV can, thus, be used to guide the postsurgical follow-up treatment at 3 months after BPH surgery.

Keywords: laser; outcome; prostate-specific antigen velocity; prostatic hyperplasia; quality of life.