Prostatic-specific antigen velocity after holmium laser enucleation of the prostate: possible predictor for the assessment of treatment effect durability for benign prostatic hyperplasia and detection of malignancy.

OBJECTIVES

To evaluate the prostate-specific antigen velocity (PSAV) as an indicator for effectiveness and durability of size reduction after holmium laser enucleation of the prostate (HoLEP). Additionally, PSAV monitoring in the detection of prostate cancer was also evaluated.

METHODS

Between 1998 and 2006, we reviewed the prostate-specific antigen (PSA) data of 335 men who underwent HoLEP and had a complete PSA data including preoperative PSA, postoperative PSA (reset), and a minimum of 2 annual PSA readings after PSA reset. PSAV was calculated by 3 methods--simple arithmetic method, linear regression method, and rate method.

RESULTS

In the benign group, the mean PSA dropped from 5.44 to 0.91 ng/mL (P <0.001). The prostate cancer patients who were newly discovered in the follow-up period had significantly higher baseline PSA (P = .032) and significantly lower PSA reduction than that of the benign group (75.39% vs 47.49%, P <.001). PSAV was calculated by 3 different methods and produced identical results; however, linear regression method produced significantly lower estimates at 7 years. In the malignant group, the mean PSAV at 1 and 3 years was higher than that of the benign group (1.28 vs 0.13 and 2.4 vs 0.09, P <0.022, 0.001, respectively).

CONCLUSIONS

HoLEP results in a significant reduction in PSA that remained at lower levels during follow-up, suggesting that the glandular size reduction after HoLEP is durable. Monitoring of PSAV is important in long-term follow-up of patients for prostatic carcinoma detection after prostatic surgery.