Serum prostate specific antigen (PSA) evaluated before and after transvesical prostatectomy
Article published in Urologia Polska 2007/60/4.

authors

Sławomir Dutkiewicz, Maciej Fortuna: Department of Urology, ATTIS Center, Warsaw and the Specialistic Hospital, Nowy Sącz, Poland

keywords

prostate, prostate specific antigen, benign prostatic hyperplasia, prostatectomy, lower urinary tract, post-void residual urine

summary

Introduction. Prostatectomy remains the definitive method of treatment of patients with benign prostatic hyperplasia (BPH), especially

in those with markedly enlarged prostate. International Prostate Symptoms Score (IPSS) and post-void residual urine volume (PVR) are used to assess BPH stage. Determination of serum prostate specific antigen (PSA) level provides an additional estimate of prostatic volume and is a tool to detect prostatic cancer. We present the course of serum PSA values assessed before the operation and at regular intervals up to 5 years postoperatively.

Material and methods. 101 patients (pts) with BPH (mean age 62.5 yrs), underwent transvesical prostatectomy. Serum PSA was determined preoperatively and at regular intervals up to 60 months postoperatively. Also, suprapubic ultrasonography (USG) was used to assess prostatic volume and to determine PVR. All pts underwent physical examination and filled in the IPSS questionnaire.

Results. Baseline average PSA (before operation) was 4.2 ng/ml (range 1.9-8.1) and after 1 month stabilized at less than 1 ng/ml (mean 0.75 ng/ml; range 0.00 to 2.0 ng/ml) during the 5 yr. follow-up. However, PSA rise over 4 ng/ml approximately 3 yrs. postoperatively

was found in 6 pts who were thus excluded from this study, despite biopsy negative for cancer, and in whom USG confirmed adenomatic tissue regrowth. Mean baseline PVR fell from 372 ml ±120 ml to 15,9 ml ±7 ml postoperatively (P<0.001) and achieved only trace levels thereafter. Similarly, average preoperative IPSS decreased from 24.5 to 2.8 1 month after the operation (P<0.001) and remained at this level throughout the follow-up.

Conclusions. 1. Following transvesical prostatectomy serum PSA decreases to less than 1.0 ng/ml by 1 month and remains at this level for up to 60 months postoperatively. 2. Open surgery of the prostate remains an effective therapeutic modality for BPH, particularly

in pts with large prostates and a history of complete urine retention.

references

Helfand B, Mouli S, Dedhia R, McVary KT: Management of lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with Open Prostatectomy: Results of Contemporary Series. J Urol 2006, 176, 2557-2561.
Grayhack JT, McVary KT, Kozłowski JM: Benign prostatic hyperplasia In: Gillenwater JY, Grayhack JT, Howards SS, and Mitchell ME(ed): Adult and Pediatric Urology, 4th ed., Philadelphia, Lippincott Wiliams and Wilkins, 2002, pp. 1401-1470.
Marks LS, Roehrborn CG, Andriole GL: Prevention of benign Prostatic Hyperplasia Disease. J Urol 2006, 176, 1299-1306.
Klomp MLF, Hendrix AJM, Koyzer JJ: The effect of transrectal ultrasonography
(TRUS) including digital rectal examination (DRE) of the prostate on the level of prostate specific antigen (PSA). B J Urol 1996, 73, 71-74.
Dutkiewicz S, Stępień K, Witeska A: Effect of rectal examination of the patinets with prostatic adenoma on the plasma concentration of the prostatic specific antigen (PSA). Int Urol Nephrol 1996, 28, 211-214.
Dutkiewicz S, Witeska A, Stępień K: Relationship between prostate specific
antigen, prostate volume, retention volume and age in benign prostate hyperprophy (BPH). Int Urol Nephrol 1995, 27, 6, 763-768.
Dutkiewicz S, Stępień K, Witeska A: Bladder catheterization on plasma prostate specific antigen in patients with benign prostatic hyperplasia and complete urine retention. Materia Medica Polona 1995, 27, 2, 71-73.
Dutkiewicz S, Stępień K: Serum PSA levels at 6 month after surgery, TURP or Doxazosin therapy for BPH. Materia Medica Polona 1996, v. 28, Fasc. 2, 69-70.
Serretta V, Morgia G, Fondacaro L et al: Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990’s: a contemporary
series of 1800 inteventions. Urology, 2002, 60, 623-625.

correspondence