MP71-05 ENUCLEATION OF THE TRANSITION ZONE AND THE EFFECT ON PSA IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation and Symptoms1 Apr 2015MP71-05 ENUCLEATION OF THE TRANSITION ZONE AND THE EFFECT ON PSA IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS Osayuki Nehikhare, Giancarlo Marra, Sohel Samad, Janette Kinsella, Oliver Brunckhorst, Kamran Ahmed, Ben Challacombe, and Rick Popert Osayuki NehikhareOsayuki Nehikhare More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Sohel SamadSohel Samad More articles by this author , Janette KinsellaJanette Kinsella More articles by this author , Oliver BrunckhorstOliver Brunckhorst More articles by this author , Kamran AhmedKamran Ahmed More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , and Rick PopertRick Popert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2618AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Rising prostate specific antigen (PSA) levels in patients with lower urinary tract symptoms (LUTS) can be a cause of concern to patients, especially those on active surveillance (AS) for low-risk prostate cancer (PCa). Holmium laser enucleation of the prostate (HoLEP) is an effective treatment of bladder outflow obstruction (BOO) in large glands. We aimed to evaluate the impact of enucleation of the transition zone (TZ) and implications of PSA observations and active surveillance. METHODS We performed retrospective analysis of 498 patients who underwent HoLEP for BOO at our institution from January 2003 – January 2014. Pre-operatively all patients underwent digital rectal examination, PSA testing, trans-rectal-guided extended biopsy and transperineal biopsy if indicated. PSA density, IPSS & Qmax was measured pre- and post –operatively. 111 (22%) patients were identified for LUTS with complete PSA data who had undergone a complete HoLEP by a single surgeon. 81/111 (73%) with LUTS had benign disease on pre-HoLEP histology and 30/111 (27%) had low-risk PCa on AS. Analysis of variance was performed to determine statistical difference (p<0.05) RESULTS Overall mean PSA density was 0.07. PSA decreased following HoLEP from 7.0ng/mL to 1.17ng/mL (83% decrease). Clinically symptoms improved, Qmax increased from 9.6ml-s to 21.4ml-s, PVR decreased from 112ml to 52ml and IPSS reduced from 22 to 7 (p<0.05). Prostate volumes were comparable in both BPH and PCa-AS cohorts, 100ml and 103ml respectively. Pre-HoLEP PSA in BPH was 8.34ng/mL and in PCa AS was 7.86ng/mL. Median PSA density in BPH was 0.07 and PCa-AS was 0.08. Median enucleated weight in BPH was 71 g whereas in PCa-AS it was 94g. Post HoLEP PSA in BPH was 0.85ng/mL and in PCa AS was 1.18ng/mL (p<0.05), a reduction of 89 and 85% respectively. CONCLUSIONS PSA often reflects transition zone hyperplasia in large prostates even with co-existing low risk PCa. Thus biopsy protocols should concentrate on peripheral zone targeting & minimise TZ sampling. Removal of the TZ following HoLEP may resolve the dilemma of PSA changes with PSA becoming more cancer specific. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e913 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Osayuki Nehikhare More articles by this author Giancarlo Marra More articles by this author Sohel Samad More articles by this author Janette Kinsella More articles by this author Oliver Brunckhorst More articles by this author Kamran Ahmed More articles by this author Ben Challacombe More articles by this author Rick Popert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...