LONG-TERM PSA TRENDS FOLLOWING SUBCAPSULAR PROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA

Paul G Espy*, Erik T Grossgold*, Adam P Klausner, Baruch M Grob, Harry P Koo
Virginia Commonwealth University, Richmond, VA

Introduction
Subcapsular prostatectomy is an effective treatment for men with lower urinary tract symptoms due to benign prostatic enlargement. This procedure involves removal of the hyperplastic adenoma, but the capsule remains intact. Therefore, patients require PSA screening postoperatively. The purpose of this investigation was to evaluate PSA trends following subcapsular prostatectomy.
Patients and Methods
PSA data from patients following subcapsular prostatectomy were retrospectively reviewed. Thirty-seven men with an average age of 70 years and surgical specimen weight of 88g were followed for a mean of 42 months.
Results
Four patients (11%) were diagnosed with prostate cancer (CaP) based on surgical specimen (N=2; Gleason 2+2 and 2+5) and during follow-up (N=2; Gleason 3+4 and 4+4). PSA decreased by an average of 0.07 ng/ml per gram tissue removed. This value did not differ for patients diagnosed with CaP. Average preoperative PSA was 7.82. The initial postoperative PSA (PSAp) was <1.0 in 54%, and the average PSAp was 1.61 (0.18-9.82).
Average postoperative PSA velocity (avgVEL) was available on 21 patients, with an overall avgVEL of 0.57 ng/ml/yr (0.00-5.77). In patients with PSAp<1.0, avgVEL was 0.12 ng/ml/yr. However, in patients with PSAp>1.0, avgVEL was 1.17 ng/ml/yr (P=0.055). Three of four CaP patients (75%) had avgVEL>0.75 ng/ml/yr (average 2.06), while only 2 of 17 non-CaP patients (12%) had an avgVEL>0.75 ng/ml/yr (average 0.28).
Conclusion
PSA screening following subcapsular prostatectomy is advisable, but interpretation remains difficult. Based on this study, immediate postoperative PSA and PSA velocity may be more clinically useful than following absolute PSA alone.

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