The Natural History of Patients with Prostate Specific Antigen Elevation Receiving Holmium Laser Enucleation of the Prostate: Prospective Cohort Study

Abstract

Objectives To understand the natural history of patients with prostate specific antigen (PSA) elevation receiving Holmium Laser Enucleation of the Prostate (HoLEP) for benign prostatic hyperplasia (BPH), and to understand clinical factors correlated with PSA elevation. Subjects and Methods: Patients in the prospective database registry from our institution who underwent HoLEP between January 2010 and May 2020 were analyzed. The patients were classified into low (< 3.0ng/mL) and high ( > = 3.0ng/mL) PSA groups at baseline. Intraoperative and early postoperative outcomes were evaluated. Postoperative evaluation was performed, with PSA being evaluated at the postoperative sixth month. Factors showing correlation with PSA elevation were analyzed. Results A total of 1297 patients with a mean age of 69.7 (± 6.8 SD) years were analyzed. The baseline PSA was 4.0 (± 4.2) ng/mL, with 713 (55.0%) patients in the low PSA group (1.6 (± 0.8) ng/mL), and 584 (45.0%) patients in the high PSA group (6.9 (± 4.7) ng/mL). The PSA level decreased postoperatively by 66.6 (± 23.6)% in all patients, and 54.3 (± 23.9)% in the low PSA group, and 79.6 (± 14.7)% in the high PSA group. Conclusions In patients with LUTS and elevated PSA, significant PSA reduction and symptom improvement was observed after HoLEP.