Change in serum prostate specific antigen concentration after holmium laser enucleation of the prostate: a marker for completeness of adenoma resection?
OBJECTIVE
Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for the treatment of benign prostatic hyperplasia (BPH). To date, changes in serum prostate specific antigen (PSA) after HoLEP have not been published. We hypothesized that HoLEP produces a diminution in PSA similar to that produced by the gold-standard therapies for BPH. To test this hypothesis, we have examined PSA data before and after HoLEP from two institutions performing high volumes of this procedure.


METHODS
Between August 1998 and September 2004, 509 HoLEPs were performed at two institutions for which complete PSA data were available. Preoperative demographic and transrectal ultrasonography (TRUS) volume measurements were recorded; postoperative pathology and TRUS volume were obtained. Change in PSA as a function of the weight of prostate resected and the relation of preoperative TRUS volume to PSA was determined.


RESULTS
The average weight of adenoma resected was 49.8 g (range 5-300 g) in the McGill group and 90.4 g (range 7.9-312 g) in the Methodist Hospital group. The mean decrease in PSA was 81.7% in the McGill group (range 6.0-1.1 ng/mL; P < 0.0001) and 86.0% in the Methodist Hospital group (range 8.6-1.2 ng/mL; P < 0.0001). Log transformed preoperative PSA correlated well with TRUS volume (r = 0.45), as did the weight of adenoma resected with absolute change in PSA (r = 0.38). The TRUS volume decreased significantly, from 111.9 cc to 26.5 cc, in the Methodist Hospital group (P < 0.0001).


CONCLUSIONS
The HoLEP procedure produces a significant diminution in PSA that correlates well with the weight of adenoma resected. Measurement of PSA may be a useful tool for the objective assessment of ablative therapies for BPH, as the reduction in PSA corresponds well with the amount of adenoma removed.
Tinmouth
William W
WW
Methodist Hospital Institute for Kidney Stone Disease and Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Habib
Enmar
E
Kim
Samuel C
SC
Kuo
Ramsay L
RL
Paterson
Ryan F
RF
Terry
Colin L
CL
Elhilali
Mostafa
M
Lingeman
James E
JE
D000236:Adenoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D006695:Holmium; D006801:Humans; D053685:Laser Therapy; D008297:Male; D009929:Organ Size; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000097:blood / Q000473:pathology / Q000601:surgery*
D015415:Biomarkers; D017430:Prostate-Specific Antigen; D006695:Holmium