Detection of Prostate Cancer and Changes in Prostate-Specific Antigen (PSA) Six Months after Surgery for Benign Prostatic Hyperplasia in Patients with Elevated PSA

Abstract

Objective: To evaluate early postoperative results of patients with elevated prostate-specific antigen (PSA) levels who underwent surgery due to benign prostatic hyperplasia (BPH). Patients and Methods: 64 patients who had lower urinary tract symptoms (LUTS), normal digital rectal examinations (DRE), elevated PSA levels and prostate biopsies reported as being benign pathologically in specimens obtained by transrectal ultrasound (TRUS)-guided biopsies, were included in the study. Patients were assessed in accordance with PSA density, free/total PSA ratio and uroflowmetric studies. Patients had no cancer pre- and postoperatively (according to operative specimens). Six months postoperatively, 32 patients were accepted for re-evaluation for all PSA parameters, routine tests and prostatic biopsies. Results: 64 patients with a mean age of 66.8 (SD 6.72) were included in the study. Total PSA average value was 14.38 (SD 7.49) ng/ml. Free PSA average value was 2.11 (SD 1.43) ng/ml. Average PSA density and free/total PSA ratio were 25.19 SD (14.12) ng/ml/cm³ and 14.53% (SD 5.35%) respectively. 56 patients had BPH, 7 had chronic prostatitis and 1 had prostatic intraepithelial neoplasia (PIN) preoperatively with biopsies. Re-biopsy of the patient with PIN was reported as BPH. In pathologic examination with resected tissues postoperatively, 49 patients had BPH, 14 had chronic prostatitis and 1 had PIN. In the sixth month, average values of free/total PSA were 0.45 (SD 0.26) and 3.71 (SD 4.96) ng/ml respectively. Average PSA density and free/total PSA ratio were 12.41 (SD 13.8) ng/ml/cm³ and 19.59% (SD 10.33%) respectively. There were significant decreases in PSA densities (p < 0.001) and increases in free/total PSA ratios (p = 0.004). Seven patients still had elevated PSA levels 6 months postoperatively. Three of 7 patients were reported as chronic prostatitis. One of them was indicated as prostatic carcinoma who was reported as PIN preoperatively. All other patients were stated as BPH at re-biopsies. Conclusion: If pretreatment biopsies are negative and operative specimens are also benign in patients with high PSA values, these patients can be followed up like usual BPH patients, but long-term follow-up is still unclear.

Patients with Elevated Serum PSA and Indwelling Catheter after Acute Urinary Retention: Prospective Study of 63 Patients with 7-Year Follow-Up

“…This is comparable with the results (11%) reported by Boddy et al It is interesting that the PSA rise in the first 6 months after operation was generally induced by the inflammatory process: carcinoma was found in only 1 of 6 patients who underwent biopsies during this period. These data are very similar to those reported by Ozden et al [23]. It must be also emphasized that 37% of our patients were actively requested to come back for follow-up visits.…”

Holmium laser enucleation of the prostate: Methods and outcomes

“…This is in agreement with our experience with an 85.5% reduction in PSA with a mean tissue weight of 118 G in our combined HoLEP and upper tract stone procedure cohort. PSA reductions of 85.5% to 91.7% for HoLEP [16,36] compare favorably with decreases of 71.3% to 95.6% for open prostatectomy [45][46][47] and of 69.7% to 83.5% for TURP [45][46][47][48]. These large decreases in PSA objectively corroborate our impression that HoLEP provides a thorough resection of prostatic tissue and that the amount of reduction in PSA appears to be an excellent surrogate measurement of adenomatous tissue removal.…”

“…HoLEP offers significant advantages over TURP and open prostatectomy and should be considered as primary therapy for every patient requiring surgical therapy for BPH. [36] HoLEP (10) 85.5 6.2 0.9 118 6 Ozden et al [47] Open/TURP (32) 74.2 14.8 3.7 N/A 6 Marks et al [45] Open/TURP (82) 71.3 4.6 0.7 35 6 Aus et al [48] TURP (190) 69.7 6 1.9 33.5 3 Stamey et al [46] Open (7) 95. 6 24.1 1 88.9 N/A Stamey et al [46] TURP (73) 83.5 7.9 1.3 29 N/A Hai and Malek [49] KTP (10) 42.4 3.3 1.9 11.1 12 BPH-benign prostatic hyperplasia; HoLEP-holmium laser enucleation of the prostate; KTP-potassium titanyl phosphate; PSA-prostate-specific antigen; TURP-transurethral resection of the prostate.…”

Antibacterial therapy improves the effectiveness of prostate cancer detection using prostate-specific antigen in patients with asymptomatic prostatitis

“…Prostate volume and symptomatic prostatic inflammation are the two most important factors contributing to the elevated PSA levels in men without clinically detectable PC [13]. Recently, studies have shown that asymptomatic prostatitis can elevate the PSA significantly [14][15][16][17]. In this study, the relationship between asymptomatic prostate inflammation and PSA elevation was not assessed.…”