Prostate specific antigen measurements after minimally invasive surgery of the prostate in men with benign prostatic hypertrophy.

There is a trend of minimally invasive surgery in the treatment of benign prostatic hypertrophy (BPH). Studies have examined levels of prostate specific antigen (PSA) in patients after open prostatectomy or transurethral resection of prostate (TURP) and noted reset of PSA to lower values after surgery. We reviewed PSA levels in patients after minimally invasive procedures to determine if levels were reset. There were 120 patients (age 45-70) enrolled in the study. Fifty patients underwent laser ablation, 20 patients had electrovaporization (TVP) and 50 patients underwent TURP. PSA measurements were obtained prior to and after surgical procedures in a three-year follow-up. Mean pre-operative PSA was 2.8 (+/-0.34) ng/ml for laser cohort, 3.2 (+/-0.31) ng/ml for the TURP group and 2.3 (+/-0.42) ng/ml for TVP patients (P=0.33). At 1 y follow-up, mean PSA decreased 32% for laser patients, 46% for the TURP cohort and 8% for TVP group. The largest mean decrease in PSA velocity was-1.5 (+/-0.31) ng/ml per y for TURP followed by 0.9 (+/-0.29) ng/ml per y for laser patients and-0.1 (s.d.+/-1.2) ng/ml per y for TVP group in y 1. The TURP group maintained the largest decrease in PSA velocity in y 2,-0.6 (+/-0.26) ng/ml per y. Three patients (2-TURP, 1-TVP) were diagnosed with prostate cancer during follow-up. In conclusion, serum PSA levels were reset at lower levels following different surgical interventions. This lower level of PSA remained decreased for 2 y post-procedure. Urologists should be cognizant of this reset level and monitor PSA levels for possible increases to screen for prostate cancer in this patient population. Prostate Cancer and Prostatic Diseases (2000) 3, 200-202

A randomized prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia.

OBJECTIVES: To compare the safety and efficacy of laser ablation of the prostate, one of the minimally invasive treatments available for men with benign prostatic hyperplasia, to transurethral resection of the prostate (TURP). METHODS: A prospective randomized study of 100 men with benign prostatic hyperplasia, with 50 patients in each treatment arm, was conducted. All patients met the entry criteria: age older than 45 years, no history of carcinoma of the prostate, a peak flow rate less than 15 mL/s, medical therapy failure, and the ability to undergo regional or general anesthesia. All patients underwent a preoperative evaluation consisting of the American Urological Association (AUA) symptom score, uroflowmetry, pressure-flow study, transrectal ultrasound for prostate volume, and serum prostate-specific antigen determination. Patients underwent either TURP or laser ablation of the prostate using the potassium titanyl phosphate (KTP)/neodymium: yttrium-aluminum-garnet laser. Patients were seen for follow-up at 1, 3, 6, and 12 months. RESULTS: The mean age was 68.2 years (range 45 to 90) for the laser group and 67.4 years (range 54 to 82) for the TURP group. The mean AUA symptom score was 22 for the laser group and 21 for the TURP group. The mean peak uroflow rate was 7.6 +/- 3.4 mL/s for the laser group and 6.5 +/- 4.0 mL/s for the TURP group. At 12 months of follow-up, the mean AUA symptom score had decreased to 7 (-69.5%) for the laser group and to 3 (-80.9%) for the TURP group. The mean peak uroflow rate increased to 15.4 mL/s (+ 107.8%) for the laser group and to 16.7 mL/s (+ 150.7%) for the TURP cohort. Seventy-five percent of the laser group had a 50% or greater decrease in their individual AUA symptom score compared with 93% of the TURP group. Sixty-five percent of the laser cohort had a 50% or greater increase in their peak uroflow rate compared with 75% of the TURP cohort. CONCLUSIONS: Laser prostatectomy produced improvements in the peak flow rate and symptom score similar to those produced by TURP. The patients who underwent laser treatment required a longer period to reach maximum improvement, which probably reflects the lack of tissue debulking at the time of surgery. Further improvement in laser technology will be required to produce more immediate results.

Electrovaporization of the prostate versus laser ablation of the prostate in men with benign prostatic hypertrophy: a pressure-flow analysis.

PURPOSE: To urodynamically assess the outcome results in a prospective cohort study of electrovaporization of the prostate (TVP) versus laser ablation of the prostate (LAP) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A randomized cohort of 10 men were enrolled to undergo a TVP procedure and a second cohort of 10 patients to undergo LAP. Preoperatively and at the 6-month follow-up all patients underwent a pressure-flow urodynamic study. Transrectal ultrasound for prostatic volume was performed at the time of enrollment and at the 6-month follow-up. RESULTS: Preoperatively, all patients except 1 were in the obstructed or equivocal range according to the Abrams-Griffin nomogram. At the 6-month follow-up the mean maximum detrusor pressure (Pdet) maximum flow rate (Qmax) for both groups of patients moved into the equivocal range. The mean prostatic volume for the TVP patients decreased 20% in comparison to a 2% decrease in prostatic volume for LAP patients. Both groups experienced similar decreases in the American Urological Association (AUA) symptom scores and increases in peak flow rates at the 6-month follow-up. CONCLUSION: Both treatment groups demonstrated a relief in symptoms by urodynamic assessment and AUA symptom score. This was present even though both groups had only a minimal decrease in prostatic volume. A reduction in prostate volume does not appear to be a prerequisite for improvement of symptoms from BPH.

Prostate specific antigen in black and white men after hormonal therapies for prostate cancer.

PURPOSE: Prostate cancer deaths usually result from proliferation of the androgen independent malignant phenotype, and in the United States the survival of black men with metastatic cancer is less favorable than that of white men. We compared prostate specific antigen (PSA) functions after hormonal therapies in men of both races to investigate potential differences in the biology of androgen independent cancer. MATERIALS AND METHODS: The PSA nadir after gonadal androgen withdrawal was determined in 217 black and 188 white men with localized or metastatic cancer. The time to PSA elevation and PSA doubling time were determined in 62 black and 27 white men with biochemical relapse. Biochemical response to deferred flutamide treatment and flutamide withdrawal was assessed in 87 and 11 black and 30 and 10 white men, respectively. RESULTS: There were no significant racial differences in the PSA nadir when controlled for clinical stage and pretreatment PSA, or in PSA doubling time when controlled for clinical stage, PSA nadir and month of PSA elevation. The biochemical response to deferred flutamide therapy and flutamide withdrawal was the same in black and white men. CONCLUSIONS: The burden and growth rate of androgen independent cancer estimated from PSA functions after gonadal androgen withdrawal, and the impact of deferred antiandrogen therapy on the serum PSA are similar in black and white men. These findings suggest that racial differences in the biology of androgen independent carcinoma do not contribute to the inferior survival of black men with metastatic prostate cancer.

Co-morbidities and survival of men with localized prostate cancer treated with surgery or radiation therapy.

PURPOSE: We determined the impact of preexisting co-morbidities on survival of men with clinical stages T1b and T2NXM0 prostate cancer treated with surgery or radiation therapy. MATERIALS AND METHODS: A weighted co-morbidity score was determined for 276 consecutive men treated with surgery (138) or radiation therapy (138) at a Veterans Affairs medical center and was correlated with actuarial freedom from death due to co-morbid disease. RESULTS: After a median potential followup of 7.0 years 91 patients (33%) died of co-morbid disease and 20 (7%) died of cancer related causes. There were highly significant correlations between actuarial survival and weighted co-morbidity (p < 0.000001), and the 10-year actuarial survivals in men with no or severe co-morbidities were 66 and 9%, respectively. Associations between patient age and co-morbidity score were highly significant (p < 0.0001). The age adjusted risk of co-morbid death was 5.7 times greater in men with severe compared to no co-morbidities. There were also significant correlations between actuarial survival and weighted co-morbidity among patients treated with surgery (p = 0.02) and radiation therapy (p = 0.0002). Patient age and severity of co-morbidities were significantly greater among men treated with radiation therapy compared to surgery, and age adjusted risk of co-morbid death among men with a co-morbidity score of 1 was 3.8 times greater among men treated with radiation therapy (p = 0.025). CONCLUSIONS: Cancer related deaths are unusual within 5 to 10 years after surgery or radiation therapy in men with stages T1b and 2 prostate cancer. The risk of death during this interval is directly related to the severity of co-morbid conditions, which should be factored in an individual when assessing the advisability of therapeutic intervention. Since patient co-morbidities impact all cause survival, quantitative assessment of co-morbidities using validated instruments offers a method to control partially for the variabilities of health status among men receiving different treatments for localized prostate cancer.