MedWire News: Prostate cancer patients can be distinguished from those with histologic benign prostatic hyperplasia (BPH) using postoperative prostate-specific antigen (PSA) levels and velocity, conclude US researchers.
After treatment for BPH, prostatic adenoma tissue remains, which places patients at risk for developing prostate cancer. As different amounts of prostate tissue remain after different procedures, the utility of PSA testing for prostate cancer screening in such patients is unclear.
To investigate further, Kevin McVary, from Northwestern University in Chicago, Illinois, and team studied 343 patients who had undergone transurethral resection of the prostate (TURP), 54 who had undergone holmium laser resection of the prostate (HoLRP), and 68 who had undergone open prostatectomy (OP).
Serum PSA measurements were obtained regularly pre-operatively and ≤10 years postoperatively. In all, 444 patients had BPH and met the inclusion criteria of no pre-operative prostate cancer diagnosis, no prostate cancer adjuvant therapy, and sufficient PSA values, of whom 73.7% had undergone bipolar or monopolar TURP, 11.6% had undergone HoLRP, and 14.7% OP.
Patients who underwent OP had significantly higher pre-operative serum PSA values than patients in the TURP and HoLRP groups, at 10.5 ng/ml versus 4.3 ng/ml and 3.2 ng/ml, respectively, the team reports in the journal Urology.
Incidental prostate cancer was diagnosed in 8.7% of TURP patients, 1.9% of HoLRP patients, and 17.6% of OP patients. Additional treatment was provided to 17 TURP patients and four OP patients, with the remainder undergoing a watchful waiting strategy.
There were no significant differences in pre-operative PSA levels or velocity between patients with presumed histologic BPH and those with incidental cancer who underwent watchful waiting.
However, the team found that postoperative PSA values were significantly higher in prostate cancer patients who underwent watchful waiting than in those who had BPH, at 2.4 ng/ml versus 1.6 ng/ml in the TURP group and 4.1 ng/ml versus 1.0 ng/ml in the OP group. A similar pattern was seen for postoperative PSA velocity, at 0.38 ng/ml/year versus 0.06 ng/m/year in the TURP group and 0.47 ng/ml/year versus -0.13 ng/ml/year in the OP group.
“The results of the present study suggest that various surgical therapies are associated with different PSA nadirs, presumably dependent on the completeness of the resection,” the team writes.
“In addition, the postoperative PSA velocity can be used with the postoperative PSA nadir to distinguish prostate cancer from histologic BPH only.”
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