Comparison of surgical efficiency by assesing preoperative and postoperative prostate specific antigen levels in whom transurethral and transvesical prostatectomy were performed due to benign prostatic hyperplasia

Objective: To investigate the correlation between extracted tissue amount and prostate specific antigen (PSA) decline in benign prostatic hyperplasia (BPH) patients treated with transvesical prostatectomy (TVP) and transurethral resection of prostate (TURP) and also to determine baseline PSA levels for prostate cancer screening whom underwent these procedures for benign diseases.Materials and methods: Between May 2008 and April 2011, a total of 214 patients who underwent TVP (n:79) and TURP (n:135) with histopathologically, diagnosis of BPH was confirmed were enrolled to the study. The mean age of patients was 68.2 years (50-86) in TVP group and 65.7 years (50-79) in TURP group. All patients had rectal examination, serum total and free PSA levels measurement, transrectal ultrasonography (TRUS), uroflowmeter, and International Prostate Symptom Scoring before the operation. In the postoperative3rd month, the PSA measurement was repeated, and the correlation between the decrease in total and free PSA levels and the amount of tissue resected during the procedure was investigated.Resuts: Before the procedure the prostate weight measured with TRUS was 86.3 ± 50.7 g in TVP group and 44.8 ± 15.4 g in TURP group (p < 0.001). The mean total PSA was 7,3 ± 6,1 ng/ml, free PSA was 1.4 ± 1,3 ng/ml in TVP group and the mean total PSA was 2,9 ± 2,1 ng/ml, free PSA was 0,7 ± 0,4 ng/ml in TURP group. The mean weight of prostate enucleated with TVP was 70.6 ± 33.3 g and the mean weight of prostate resected with TURP was 23.2 ± 8.8 g (p < 0.001). In the postoperative 3rd month, the mean total PSA level was 1.6 ± 1.4 ng/ml, the free PSA level was 0.4 ± 0.3 ng/ml in TVP group and the mean total PSA level was 1.4 ± 1.1 ng/ml, the free PSA level was 0,3 ± 0,2 ng/ml in TURP group. In both TVP and TURP group a positive correlation between the amount of tissue extracted and the total-free PSA levels before and after the procedure was detected. In TVP group mean enucleated prostate volume was 81.4%. The decrease in total and free PSA levels was 79% and 58%, respectively. In TURP group mean resected prostate volume was 52%. The decrease in total and free PSA levels was 47% and 42%, respectively. For 1 g of prostate mass enucleated in TVP group, the total and free PSA levels decreased 0,145 ng/ml and 0,03 ng/ml, respectively. In TURP group for 1 g of prostate mass resected, the total and free PSA levels decreased 0,103 ng/ml and 0,013 ng/ml, respectively.Conclusion: Total-free PSA levels decrease with the amount of tissue extracted during TVP and TURP in BPH patients. More adenoma tissue was significantly extracted in TVP groupand the decrease of PSA per gram of tissue after TVP was more than TURP group. This is the indication of that radical resection concept is not realistic and transitional zone can only be enucleated completely in TVP group.In line with the literature in terms of post-TURP prostate adenocarcinoma PSA cut-off value of 2 ng /ml might be taken and we should be careful at the much lower levels of PSA after TVP.Keywords: Benign prostatic hiperplasia; prostate specific antigen; transvesical prostatectomy; transurethral resection of prostate