PSA supernormalisation: a surrogate of complete adenoma removal in men with benign prostatic hyperplasia

It is known that serum prostate-specific antigen levels (PSA) decrease gradually following surgery for benign prostatic hyperplasia (BPH), but there is not an established cut-off value for normal PSA after relief of obstruction. We evaluated the impact of prostatic adenoma enucleation on PSA levels in 110 patients who underwent transvesical suprapubic adenomectomy for symptomatic BPH. We examined PSA levels before and after open surgery and weight of the prostatic adenoma as measured by the pathologist. Forty-eight percent of the patients had a preoperative PSA level between 0 and 4, 29% between 4 and 7, and 23% between 7 and 10 ng/ml. In patients with suspected abnormality on digital rectal examination or PSA > 4.0 ng/mL systematic multisite biopsies were performed preoperatively to rule out prostate cancer. The mean weight of enucleated adenoma was 87 gr (range 50-201). The mean serum PSA decreased from 4.8 ng/ml preoperatively to 0.5 ng/ml postoperatively. The mean decrease in PSA was 90% (range 70-99%). PSA was resetted at lower level in all patients irrespectively of baseline PSA levels or BPH weight. The transvesical suprapubic adenomectomy supernormalises serum PSA lower than 1 ng/ml in 96% of patients. 100% of patients have a postoperative PSA value < 1.5 ng/ml. PSA supernormalisation represents an objective measure of complete adenoma removal. The urologists should be aware of this resetted level and they should take account of it when different ablative therapies for BPH are confronted.