Serum prostate specific antigen (PSA) evaluated before and after transvesical prostatectomy
Article published in Urologia Polska 2007/60/4.
Sławomir Dutkiewicz, Maciej Fortuna
- Department of Urology, ATTIS Center, Warsaw and the Specialistic Hospital, Nowy Sącz, Poland
prostate, prostate specific antigen, benign prostatic hyperplasia, prostatectomy, lower urinary tract, post-void residual urine
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.
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Slawomir A. Dutkiewicz
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02-786 Warsaw, Poland
phone: +48 502 025 880