[Preoperative PSA levels and development of PSA after 180-W XPS greenlight laser treatment of the prostate: what is the reality in clinical routine practice?].

Introduction:  The aim of this retrospective study was to evaluate preoperative levels of PSA (prostate-specific antigen) and the postoperative development after 180-W XPS™ greenlight laser treatment of the prostate under real-world conditions.

Method:  Preoperative PSA levels were evaluated in 749 patients undergoing a 180-W XPS greenlight laser procedure from 2012 to 2017 in Witten, Germany, in relation to age, volume of the prostate, urinary tract infection, Foley catheter and co-morbidities. The postoperative development of PSA was identified by retrieving PSA levels from general practitioners or urologists.

Results:  The average age of the patients was 73.33 ± 9.26 years. The prostate volume measured by rectal ultrasound was 42.42 ± 18.33 ml. Median preoperative PSA was 2.59 ng/ml. In 268 patients (35.8 %), the PSA level was above 4 ng/ml. It was evaluated by prostate biopsy in 106 patients (39.6 %). 6 months after the surgical procedure (n = 86), PSA decreased to 1.25 ng/ml and increased slightly to 1.46 ng/ml after 12 months (n = 126). Logistic regression analysis demonstrated that a PSA level elevated to more than 4 ng/ml preoperatively is related to prostate volume (p = 0.001) the existence of a transurethral Foley catheter (p = 0.002), but not to age (p = 0.349), the existence of a suprapubic catheter (p = 0.207), an infection of the lower urinary tract (p = 0.966) and the number of co-morbidities mentioned in the discharge letter (p = 0.936).

Discussion:  In line with expectations and clinical trials, there was a postoperative decrease of PSA by more than a half of the preoperative value. Significant factors related to preoperative elevation of the PSA level were prostate volume, a transurethral Foley catheter instead of the suprapubic type of catheter and a urinary infection. Although elevated PSA levels were seen in about one third of patients, evaluation by prostate biopsy was only performed in 39.6 % of these patients due to their performance status and other clinical issues.