Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

Hahn-Ey Lee; ByungWon Kim; Hyun Sik Yoon; Jungyo Suh; Seung-June Oh

doi:10.5213/inj.2244176.088

Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

Int Neurourol J. 2022 Sep;26(3):248-257. doi: 10.5213/inj.2244176.088. Epub 2022 Sep 30.

Authors

Hahn-Ey Lee¹, ByungWon Kim², Hyun Sik Yoon³, Jungyo Suh⁴, Seung-June Oh^{1

5}

Affiliations

¹ Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
² Department of Statistics, College of Natural Sciences, Kyungpook National University, Daegu, Korea.
³ Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea.
⁴ Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁵ Department of Urology, Seoul National University Hospital, Seoul, Korea.

Abstract

Purpose: This study investigated functional outcomes in lower urinary tract symptoms (LUTS), the incidence of incidental prostate cancer (PCa), and changes in prostate-specific antigen (PSA) levels after holmium laser enucleation of the prostate (HoLEP) in patients with elevated PSA and benign prostatic hyperplasia (BPH).

Methods: A retrospective review of a prospectively designed protocol for patients who underwent HoLEP at our institution from January 2010 to May 2020 was conducted. Patients were classified into low-PSA (<3.0 ng/mL) and high-PSA (≥3.0 ng/mL) groups at baseline. Follow-up for PSA was performed at the sixth postoperative month. Baseline and postoperative clinical parameters, functional parameters, PCa incidence, and postoperative changes in PSA were compared between the lowand high-PSA groups.

Results: The baseline PSA of 1,296 patients (mean age, 69.7±6.8 years) was 4.0±4.1 ng/mL, with 712 patients (55.0%) in the low-PSA group (1.6±0.8 ng/mL), and 584 patients (45.0%) in the high-PSA group (6.9±4.7 ng/mL). Incidental PCa was detected in 82 patients (6.3%), with a similar incidence in the low-PSA (41 patients, 5.9%) and high-PSA (41 patients, 7.0%) groups (P>0.05). At 6 months postoperatively, both groups showed significant improvements in the maximum flow rate, postvoid residual volume, and all domains of the International Prostate Symptom Score (P<0.05). At postoperative 6 months, the PSA level significantly decreased by 66.6%±23.6% in all patients (54.3%±23.9% in the low-PSA group; 79.6%±14.7% in the high-PSA group) (P<0.05), and the PSA levels of 1,264 patients (97.6%) had normalized.

Conclusion: In patients with elevated PSA presenting with LUTS/BPH, our study demonstrated significant improvements in functional parameters and decreased PSA after HoLEP. The incidental PCa detection rate did not show a statistically significant difference between the low- and high-PSA groups. Timely surgery for LUTS/BPH without delay due to PSA monitoring should be considered.

Keywords: Lasers; Lower urinary tract symptoms; Prostate-specific antigen; Prostatic hyperplasia; Solid-state; Transurethral resection of prostate.