PSA, TRUS data reflect adequacy of BPH treatments

The researchers drew two primary conclusions based on data from a literature search and from randomized, controlled trials performed at their institution: First, that procedures using bladder neck incision, laser ablation, and microwave energy result in smaller declines in PSA and TRUS volume than does transurethral resection of the prostate; and second, that greater declines in PSA and TRUS volume appear to be markers for better clinical outcomes.

Peter Gilling, MD, urologic consultant at Tauranga Hospital in Tauranga, New Zealand, and colleagues reported the study results at the recent Urological Society of Australasia annual meeting here.

A Medline search was conducted on six current endoscopic treatments for BPH: transurethral needle ablation (TUNA), bladder neck incision (BNI), contact laser ablation of the prostate (CLAP), photoselective vaporization of the prostate (PVP), TURP, and Holmium laser enucleation of the prostate (HoLEP). Pre- and postoperative PSA data and change in PSA were extracted from the literature review, as were data on TRUS volume decline.

Data were also analyzed from randomized clinical trials carried out at Tauranga Hospital on TURP (two studies), HoLEP (three studies), Holmium laser resection of the prostate (HoLRP), plasmakinetic enucleation,, and Holmium BNI (one study each). Data were included only if adequate PSA information was recorded before and after surgery.

Comparative results

Mean PSA and TRUS volume declines found in the literature search were 0% and 0%, respectively, for TUNA; 45% and 15%, respectively, for CLAP; 41% and 37%, respectively, for PVP; 73% and 50%, respectively, for TURP; and 83% and 76%, respectively, for HoLEP. Mean PSA decline was not available for BNI, and TRUS volume decline for this procedure was 0%.

Data from the Tauranga Hospital trials showed the following declines for PSA and TRUS volume: Holmium BNI (36% and 0%), TURP (51% and 44%), HoLRP (56% and 44%), and HoLEP (86% and 67%).

"BNI, laser ablation, and microwave appear to result in less PSA decline and TRUS volume fall than after TURP and, by inference, less complete removal of adenoma. HoLEP gives larger percentage falls," the authors stated.

"This is likely to the fact that a complete enucleation of the adenoma is performed with HoLEP," Dr. Gilling said, "whereas a variable channel is created by the other techniques with often considerable adenoma remaining."

The researchers also noted significant correlations between PSA and TRUS volume percentage decline with pathology weight and PSA percentage decline with improvement in urodynamic parameters. Pathology weight also correlated with improvement in AUA symptom score.

They concluded that greater falls in PSA and TRUS volume are associated with better clinical results and, ultimately, may be associated with more durable outcomes.

Dr. Gilling is a meeting participant for Lumenis.