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Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction

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Abstract

Purpose

To evaluate and provide a comprehensive literature review of Prostate specific antigen (PSA) dynamics after various surgical procedures for benign prostatic hyperplasia (BPH).

Methods

A thorough PubMed database search was performed over last 30 years including terms “PSA” and various surgical procedures for BPH. PSA nadir after various procedure was evaluated. The post-operative improvement in International Prostate Symptom Score, maximum void rates and post-void residue after surgeries were recorded. An indirect correlation was made between PSA nadir and outcome of various BPH surgical procedures.

Results

Enucleation procedures like simple prostatectomy and endoscopic enucleation of prostate (EEP) produced maximum drop in PSA level after surgery and were associated with the highest improvement in post-operative parameters. The PSA nadir following resection techniques like transurethral resection of prostate and Holmium laser resection of prostate and vaporization technique was variable and less robust when compared to EEP. Newer techniques like Aquablation, Rezum, Urolift, Prostate artery embolization and Temporary implantable nitinol devices (iTIND) produce relatively less reduction in PSA and lesser percentile improvement in post-operative parameters.

Conclusions

Various surgical procedures for BPH result in varying PSA nadirs level. Enucleation procedures and simple prostatectomy produce the most drastic and sustained decrease in PSA. There is a possible indirect evidence suggesting that the level of PSA nadir corresponds closely with the degree of post-operative improvement and durability of the procedure. Establishing the new PSA nadir at 3–6 months after the procedure is recommended as a part of routine surveillance for prostate cancer in eligible patients.

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Abbreviations

BPH:

Benign prostatic hyperplasia

CaP:

Prostate cancer

TZ:

Transition zone

PSA:

Prostate specific antigen

TURP:

Transurethral resection of prostate

OSP:

Open simple prostatectomy

LSP:

Laparoscopic simple prostatectomy

RSP:

Robotic simple prostatectomy

EEP:

Endoscopic enucleation of prostate

TUMT:

Transurethral microwave therapy

TUNA:

Transurethral needle ablation

PAE:

Prostate artery embolization

TIND:

Temporary implantable nitinol device

PUL:

Prostatic Urolift

PVP:

Photoselective vaporization of prostate

HoLAP:

Holmium laser ablation of prostate

PSAD:

Prostate specific antigen density

PSAV:

Prostate specific antigen velocity

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Bhat, A., Blachman-Braun, R., Herrmann, T.R.W. et al. Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction. World J Urol 40, 889–905 (2022). https://doi.org/10.1007/s00345-021-03771-w

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