PSA Can Help Identify Cancer Following Surgery for Benign Prostatic Hyperplasia

Researchers at Northwestern University (Chicago, IL, USA) conducted a retrospective review of 525 patients who had undergone one of three procedures for BPH: transurethral resection of the prostate (TURP; 343 patients), holmium laser resection of the prostate (HoLRP; 54 patients), or open prostatectomy (OP; 68 patients), between 1992 and 2007. The prostate-specific antigen (PSA) and PSA velocity values were collected at regular intervals both pre- and postoperatively for all patients, since the researchers hypothesized that the PSA level might be influenced by the efficacies of different BPH procedures. Only patients with histologic BPH and those with incidental prostate cancer who underwent a watchful waiting strategy were included.

The researchers found that the average preoperative PSA values were significantly different between the TURP, HoLRP, and OP groups. Only one patient had incidental prostate cancer in the HoLRP group. No differences were present between the preoperative PSA values for patients with histologic BPH and those with incidental prostate cancer undergoing a watchful waiting strategy. However, the postoperative PSA values were increased in the patients with prostate cancer; similarly, patients with incidental prostate cancer had a significantly elevated postoperative mean PSA velocity compared with patients without prostate cancer. The researchers therefore concluded that postoperative PSA and PSA velocity measurements could be used to distinguish patients with prostate cancer from those with histologic BPH only. The study was published ahead of print on May 8, 2009, in the online edition of Urology.

Prostatic adenoma inevitably remains after BPH surgery, and studies have determined that the level of PSA decreases by approximately 0.1-0.3 ng/ml for every gram of prostate tissue removed. Therefore, PSA levels should indicate residual hyperplastic tissue, as well as resulting cancer risk.

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