How does PSA change after water vapor therapy? A systematic review and meta-analysis

Prostate-specific antigen (PSA) kinetics following minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia (BPH) remain incompletely characterized. Water vapor thermal therapy (Rezūm™) induces targeted tissue ablation and inflammatory remodeling, potentially affecting PSA levels over time. The aim of this review was to quantify PSA changes after Rezūm therapy and explore study-level correlates of PSA dynamics through a systematic review and meta-analysis.

This systematic review followed PRISMA guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched for studies reporting baseline and post-treatment PSA after Rezūm therapy. The primary outcome was pooled mean change in PSA (ΔPSA) versus baseline at prespecified timepoints (1, 3, 6, 12 months, and last follow-up). Random-effects models using restricted maximum likelihood (REML) were applied, with heterogeneity assessed using Cochrane Q. Meta-regression explored associations between ΔPSA and study-level variables, including acute urinary retention (AUR), reintervention rates, symptom and flow improvements, and prostate volume.

Thirteen studies were included. PSA followed a biphasic pattern. At 1 month, an early postoperative increase was observed (2 studies; ΔPSA = +2.38 ng/mL, 95% CI 1.62-3.14). From 3 months onward, PSA levels declined, reaching a moderate but non-statistically significant reduction at the last available follow-up (12 studies; ΔPSA = -0.44 ng/mL, 95% CI - 0.92 to 0.04), corresponding to an approximate 10% decrease from baseline. Meta-regression showed associations between ΔPSA and AUR (β = 0.0799, p = 0.034), reintervention rates (β = -0.226, p = 0.026), Qmax improvement (β = -0.0308, p = 0.028), baseline PSA (β = -0.536, p < 0.001), and baseline prostate volume (β = -0.0861, p = 0.002).

Rezūm therapy is associated with a reproducible PSA trajectory characterized by an early transient increase followed by a moderate decline from 3-12 months (~10%). Because this late change is non-significant and within the expected variability of PSA, it is unlikely to modify follow-up strategy. Awareness of this pattern may support appropriate interpretation of PSA measurements after MIST for BPH.