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Changes in serum PSA after endoscopic enucleation of the prostate are predictive for the future diagnosis of prostate cancer

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Abstract

Purpose

After Endoscopic Enucleation of the Prostate (EEP) for benign prostatic obstruction (BPO), men remain at risk for prostate cancer (PCa). Significant PSA changes occur after enucleation, which interfere with later screening for PCa. It remains unclear which patients need further diagnostic investigations for PCa after EEP. The goal of this study was to identify an independent predictor for PCa diagnosis after Holmium Laser Enucleation of the Prostate (HoLEP) in patients whose HoLEP resection specimen did not show PCa.

Methods

Data of 773 patients who underwent HoLEP for BPO between 2010 and 2018 in a referral center were analyzed. Exclusion criteria were PCa detection in the HoLEP specimen or absence of post-operative PSA values. Patients were divided in a PCa group and Control group depending on whether or not PCa was detected during follow-up after HoLEP. The predictive value for future diagnosis of PCa of different forms of PSA-change after HoLEP was analyzed by multivariate Cox regression and ROC analysis.

Results

Overall, 24 (4.2%) patients developed PCa after HoLEP. At 5 year follow-up, the PCa-free survival rate was 85%. First post-operative PSA was an independent predictor of PCa diagnosis after HoLEP (HR 1.106, 95% CI 1.074–1.139, p < 0.001, ROC AUC 0.903) with an optimal cut-off value of 1.73 ng/ml (sensitivity 83.3%, specificity 82.3%).

Conclusions

For patients who underwent HoLEP for BPO, post-operative PSA after HoLEP is an independent predictor for future PCa diagnosis. When PSA is > 1.73 ng/ml within the first year after HoLEP, rigorous follow-up and diagnostic investigations for PCa are indicated.

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Abbreviations

AUC:

Area Under the Curve

BPH:

Benign Prostatic Hyperplasia

BPO:

Benign Prostatic Obstruction

CI:

Confidence interval

CRA:

Cox Regression Analysis

DRE:

Digital Rectal Examination

HoLEP:

Holmium Laser Enucleation of the Prostate

HR:

Hazard ratio

PCa:

Prostate Cancer

PSA:

Prostate Specific Antigen

ROC:

Receiver Operating Characteristic

SP:

Simple Prostatectomy

TURP:

Transurethral Resection of the Prostate

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Authors and Affiliations

  1. Deparment of Urology, Onze-Lieve-Vrouw Ziekenhuis Aalst, Aalst, Belgium

    E. Lambert, M. Goossens, E. Palagonia, J. Vollemaere, E. Pauwels, R. De Groote, F. D’Hondt, A. Mottrie, G. De Naeyer & P. Schatteman

  2. ORSI Acadamy, Melle, Belgium

    E. Mazzone, P. Dell’Oglio & A. Mottrie

  3. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy

    E. Mazzone

  4. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    P. Dell’Oglio

Authors
  1. E. Lambert
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  2. M. Goossens
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  3. E. Palagonia
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  4. J. Vollemaere
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  5. E. Mazzone
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  6. P. Dell’Oglio
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  7. E. Pauwels
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  8. R. De Groote
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  9. F. D’Hondt
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  10. A. Mottrie
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  11. G. De Naeyer
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  12. P. Schatteman
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Contributions

E.L: project development, data collection, data analysis, manuscript writing. M.G: project development, data collection, manuscript editing. E.P: data collection. J. Vollemaere: data collection. E.M: data analysis, manuscript editing. P.D: data analysis, manuscript editing. E.P: manuscript editing. R.DG: manuscript editing. F.D’H: manuscript editing. A.M: project development, manuscript editing. G.DN: project development, manuscript editing. P.S: project development, manuscript editing.

Corresponding author

Correspondence to E. Lambert.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Onze-Lieve-Vrouw Hospital Aalst (No. B126201941539).

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Informed consent was obtained from all individual participants included in the study.

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Lambert, E., Goossens, M., Palagonia, E. et al. Changes in serum PSA after endoscopic enucleation of the prostate are predictive for the future diagnosis of prostate cancer. World J Urol 39, 2621–2626 (2021). https://doi.org/10.1007/s00345-020-03444-0

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  • DOI: https://doi.org/10.1007/s00345-020-03444-0

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