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Updated: Mar 18, 2026

A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
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Multi-institutional evaluation of prostate specific antigen dynamics after simple prostatectomy.

Austin J Livingston1, Daniel Segal2, Sarah Attia2

  • 1Department of Urology, Duke University Medical Center, P.O. Box 3831, Durham, NC, 27710, USA. Austin.livingston@duke.edu.

World Journal of Urology
|March 16, 2026
PubMed
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Prostate cancer (PCa) screening after simple prostatectomy (SP) is challenging. Postoperative PSA levels and velocity can help identify men at risk for PCa, with an initial PSA >1 ng/mL potentially triggering further screening.

Area of Science:

  • Urology
  • Oncology
  • Medical Diagnostics

Background:

  • Men undergoing simple prostatectomy (SP) for benign conditions remain at risk for prostate cancer (PCa).
  • Current prostate-specific antigen (PSA) surveillance guidelines after SP are lacking, making PCa detection difficult.
  • Differentiating benign from malignant pathology post-SP based on PSA is crucial for timely intervention.

Purpose of the Study:

  • To compare initial postoperative PSA levels and PSA kinetics in patients with benign prostate hyperplasia (BPH) versus those diagnosed with PCa after SP.
  • To identify potential PSA thresholds for triggering further PCa investigation in the post-SP setting.

Main Methods:

  • Retrospective review of 296 patients who underwent SP at two US tertiary care centers (2014-2022).
Keywords:
benign prostate hyperplasiaprostate cancersimple prostatectomy

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  • Collected preoperative and postoperative PSA values, patient demographics, and oncologic diagnosis.
  • Categorized patients into BPH alone or PCa diagnosis groups (pre-existing or incidental).
  • Main Results:

    • No significant difference in preoperative PSA between BPH and PCa groups.
    • Initial postoperative PSA was significantly higher in the PCa group (1.37 ng/mL) compared to the BPH group (0.72 ng/mL).
    • PSA reduction was less in the PCa cohort (78%) vs. BPH (89%). Postoperative PSA velocity was significantly elevated in the PCa group (0.40 ng/mL/year vs. 0.004 ng/mL/year).

    Conclusions:

    • Initial postoperative PSA levels (at 3 months) and PSA velocity after SP can aid in identifying men at risk for PCa.
    • An initial postoperative PSA >1 ng/mL may warrant further PCa screening.
    • Larger studies are needed to establish definitive PSA cutoff values for post-SP PCa surveillance.