Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

초록

Purpose: This study investigated functional outcomes in lower urinary tract symptoms (LUTS), the incidence of incidental prostate cancer (PCa), and changes in prostate-specific antigen (PSA) levels after holmium laser enucleation of the prostate (HoLEP) in patients with elevated PSA and benign prostatic hyperplasia (BPH).Methods: A retrospective review of a prospectively designed protocol for patients who underwent HoLEP at our institution from January 2010 to May 2020 was conducted. Patients were classified into low-PSA (<3.0 ng/mL) and high-PSA (>= 3.0 ng/ mL) groups at baseline. Follow-up for PSA was performed at the sixth postoperative month. Baseline and postoperative clini-cal parameters, functional parameters, PCa incidence, and postoperative changes in PSA were compared between the low -and high-PSA groups.Results: The baseline PSA of 1,296 patients (mean age, 69.7 +/- 6.8 years) was 4.0 +/- 4.1 ng/mL, with 712 patients (55.0%) in the low-PSA group (1.6 +/- 0.8 ng/mL), and 584 patients (45.0%) in the high-PSA group (6.9 +/- 4.7 ng/mL). Incidental PCa was de-tected in 82 patients (6.3%), with a similar incidence in the low-PSA (41 patients, 5.9%) and high-PSA (41 patients, 7.0%) groups (P > 0.05). At 6 months postoperatively, both groups showed significant improvements in the maximum flow rate, postvoid residual volume, and all domains of the International Prostate Symptom Score (P < 0.05). At postoperative 6 months, the PSA level significantly decreased by 66.6%+/- 23.6% in all patients (54.3% +/- 23.9% in the low-PSA group; 79.6%+/- 14.7% in the high-PSA group) (P < 0.05), and the PSA levels of 1,264 patients (97.6%) had normalized.Conclusions: In patients with elevated PSA presenting with LUTS/BPH, our study demonstrated significant improvements in functional parameters and decreased PSA after HoLEP. The incidental PCa detection rate did not show a statistically signifi-cant difference between the low-and high-PSA groups. Timely surgery for LUTS/BPH without delay due to PSA monitoring should be considered.

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