Abstract
Purpose
To evaluate and provide a comprehensive literature review of Prostate specific antigen (PSA) dynamics after various surgical procedures for benign prostatic hyperplasia (BPH).
Methods
A thorough PubMed database search was performed over last 30 years including terms “PSA” and various surgical procedures for BPH. PSA nadir after various procedure was evaluated. The post-operative improvement in International Prostate Symptom Score, maximum void rates and post-void residue after surgeries were recorded. An indirect correlation was made between PSA nadir and outcome of various BPH surgical procedures.
Results
Enucleation procedures like simple prostatectomy and endoscopic enucleation of prostate (EEP) produced maximum drop in PSA level after surgery and were associated with the highest improvement in post-operative parameters. The PSA nadir following resection techniques like transurethral resection of prostate and Holmium laser resection of prostate and vaporization technique was variable and less robust when compared to EEP. Newer techniques like Aquablation, Rezum, Urolift, Prostate artery embolization and Temporary implantable nitinol devices (iTIND) produce relatively less reduction in PSA and lesser percentile improvement in post-operative parameters.
Conclusions
Various surgical procedures for BPH result in varying PSA nadirs level. Enucleation procedures and simple prostatectomy produce the most drastic and sustained decrease in PSA. There is a possible indirect evidence suggesting that the level of PSA nadir corresponds closely with the degree of post-operative improvement and durability of the procedure. Establishing the new PSA nadir at 3–6 months after the procedure is recommended as a part of routine surveillance for prostate cancer in eligible patients.
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Abbreviations
- BPH:
-
Benign prostatic hyperplasia
- CaP:
-
Prostate cancer
- TZ:
-
Transition zone
- PSA:
-
Prostate specific antigen
- TURP:
-
Transurethral resection of prostate
- OSP:
-
Open simple prostatectomy
- LSP:
-
Laparoscopic simple prostatectomy
- RSP:
-
Robotic simple prostatectomy
- EEP:
-
Endoscopic enucleation of prostate
- TUMT:
-
Transurethral microwave therapy
- TUNA:
-
Transurethral needle ablation
- PAE:
-
Prostate artery embolization
- TIND:
-
Temporary implantable nitinol device
- PUL:
-
Prostatic Urolift
- PVP:
-
Photoselective vaporization of prostate
- HoLAP:
-
Holmium laser ablation of prostate
- PSAD:
-
Prostate specific antigen density
- PSAV:
-
Prostate specific antigen velocity
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Bhat, A., Blachman-Braun, R., Herrmann, T.R.W. et al. Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction. World J Urol 40, 889–905 (2022). https://doi.org/10.1007/s00345-021-03771-w
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DOI: https://doi.org/10.1007/s00345-021-03771-w