"Pro/ 'Yes' for PSA Testing Before BPO Surgical Therapy" Ignoring PSA in BPE is Not Progress; It's Clinical Blindness

Although traditionally linked to prostate cancer screening, prostate-specific antigen (PSA) serves as a multifaceted clinical marker in men with lower urinary tract symptoms. PSA reflects prostate biology, predicts disease progression, and guides treatment decisions in benign prostatic enlargement. As a dynamic biomarker, changes in PSA over time indicate treatment response and disease course. PSA also facilitates oncological assessment, as enucleation reduces benign glandular interference and establishes a more reliable baseline for detecting incidental or future malignancy. Consequently, the clarity of PSA interpretation depends on the treatment approach, with complete adenoma removal yielding a more distinct clinical signal than tissue-ablative methods. PSA should be considered a continuous biomarker throughout the care pathway.