Serum prostate specific antigen levels after transurethral resection of prostate: A longitudinal characterization in men with benign prostatic hyperplasia

Purpose: We studied the long-term effects of adenomectomy on serum levels of prostate specific antigen (PSA) in men with benign prostatic hyperplasia (BPH). Materials and Methods: A consecutive series of 82 men undergoing adenomectomy for BPH between 1990 and 1992 was studied. PSA levels were determined before and serially after operation for as long as 5 years. Results: Mean PSA decreased from 4.6 ng./ml. preoperatively to 0.7 ng./ml. 6 months postoperatively. These low levels were maintained throughout the 5- year observation period. The PSA decrease correlated with grams of tissue removed (r = 0.54, p <0.001) and averaged 0.11 ng./ml./gm. Postoperatively mean PSA velocity was 0.01 ng./ml. per year, that is essentially flat, and it was not influenced by patient age, race, type of operation, grams of tissue removed, baseline PSA, PSA density or T1a lesions (7). One to 5 years after adenomectomy 6 of the 82 men had invasive prostatic carcinoma, and PSA levels and velocities remained low. Conclusions: These data support the concept of transition zone primacy in determining serum PSA. Furthermore, they suggest a possible need for a modified reference range when using PSA to screen for prostatic carcinoma in the estimated 3 million men alive in the United States who previously underwent adenomectomy for BPH.