Presentation Authors: Zain A Abedali*, Tim Large, Adam Calaway, Michael O Koch, James E Lingeman, Ronald S Boris, Indianapolis, IN
Introduction: The utilization of PSA for the diagnosis of prostate cancer has been recently challenged due to poor sensitivity. Because PSA remains a surrogate for BPH and prostate size its usefulness in predicting the presence and volume of prostate cancer is variable. Because HoLEP patients have the entirety of their transition zone removed, we hypothesized that PSA changes after surgery would be a sensitive measure of prostate cancer risk.
Methods: A retrospective review of an IRB database identified 3476 HoLEP surgeries performed at Indiana University from 2008 to 2018. 53 post-HoLEP biopsies were recorded. Demographics, PSA, prostate volume, and oncologic details were analyzed. PSA density was calculated using post-HoLEP PSA and post-operative prostate volume.
Results: A total of 53 patients underwent &[Prime]for cause&[Prime] transrectal ultrasound prostate biopsy following HoLEP at a median time frame of 16 months after HoLEP. The mean (SD) PSA prior to biopsy for these patients was 6.1 ng/mL (7.36). Cancer was identified in over 90% (48/53) of those biopsied. Patient demographics, prostate volume, PSA trends, and cancer detection rates are shown in Table 1. Of the 53 patients, 11 (20%) had clinically significant prostate cancer (Gleason 7 or higher) in the HoLEP specimen. PSA values decreased following HoLEP by a mean of 23.9%. Distribution of Gleason grade group by PSA density is shown in Figure 1. Amongst analyzed patients, a PSA of 5.8 of higher was universally associated with clinically significant disease.
Conclusions: Post HoLEP PSA and PSA density are extremely sensitive measures for selecting patients at risk for prostate cancer. Gross PSA threshold for biopsy should be lower than for non-HoLEP patients. HoLEP patients with PSA density of 0.1 or higher have a high likelihood of harboring clinically significant prostate cancer and should undergo prostate biopsy if feasible. Referring urologists and primary care physicians should be made aware of these significant risk shifts when performing routine PSA screening in patients with prior HoLEP surgery.