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 lev els of prostate specific antigen (PSA) in men with benign prostatic hy perplasia (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 lon g as 5 years. Results: Mean PSA decreased from 4.6 ng./ml. preoperativ ely to 0.7 ng./ml. 6 months postoperatively. These low levels were mai ntained throughout the 5-year observation period. The PSA decrease cor related 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. p er year, that is essentially flat, and it was not influenced by patien t age, race, type of operation, grams of tissue removed, baseline PSA, PSA density or T1a lesions (7). One to 5 years after adenomectomy 6 o f the 82 men had invasive prostatic carcinoma, and PSA levels and velo cities remained low. Conclusions: These data support the concept of tr ansition zone primacy in determining serum PSA. Furthermore, they sugg est a possible need for a modified reference range when using PSA to s creen for prostatic carcinoma in the estimated 3 million men alive in the United States who previously underwent adenomectomy for BPH.