Hasim Bakbak, Gurpremjit Singh, Ahmad Abdelaziz, Juanita Velasquez Ospina, Shlomo Resnik, Connor Stephen Nee, Archan Khandekar, Jonathan E Katz, Sanoj Punnen, Robert Marcovich, Mark L Gonzalgo, Dipen J Parekh, Hemendra Navinchandra Shah
HoLEP produces a substantial PSA 'reset' with sustained low postoperative PSA in both benign and low-risk PCa patients. Although low-risk patients showed numerically higher PSAV, shorter PSA doubling time and greater likelihood of PSA exceeding 1.0 ng/mL, overall postoperative PSA trajectories were statistically comparable between groups. These findings provide a reference for expected PSA kinetics after HoLEP in men with low-risk PCa undergoing active surveillance.
OBJECTIVES: To characterize postoperative prostate-specific antigen (PSA) kinetics after holmium laser enucleation of the prostate (HoLEP) in men with low-risk prostate cancer (PCa) managed with active surveillance and to compare these with men without PCa, establishing a benchmark for expected PSA behaviour after HoLEP in low-risk disease.
PATIENTS AND METHODS: We retrospectively reviewed a prospectively maintained HoLEP database at a tertiary centre from 2017 to 2025. Patients were stratified into benign and low-risk PCa cohorts, with low-risk PCa defined as Grade Group 1 disease. Patients with clinically significant PCa were excluded. PSA values were assessed at standardized postoperative time points up to 5 years. PSA reduction, PSA velocity (PSAV), PSA doubling time and surveillance outcomes were compared between groups.
RESULTS: A total of 769 patients were included (692 benign, 77 low-risk PCa). Baseline characteristics were broadly comparable. Both groups demonstrated marked and similar PSA reductions after HoLEP, with no significant difference in percent PSA decline from baseline (91.6% vs. 91.1%, p = 0.953) or 3-month PSA (0.39 vs. 0.40 ng/mL, p = 0.858). PSA remained low throughout follow-up in both cohorts. PSAV was numerically higher in the low-risk cohort but did not differ significantly (0.127 vs. 0.036 ng/mL/year, p = 0.259). PSA doubling time was shorter in the low-risk cohort, though not significantly (1.74 vs. 2.40 years, p = 0.297). A greater proportion of low-risk patients had PSA exceeding 1.0 ng/mL, though this was not significant (23.4% vs. 17.3%, p = 0.249).
CONCLUSION: HoLEP produces a substantial PSA 'reset' with sustained low postoperative PSA in both benign and low-risk PCa patients. Although low-risk patients showed numerically higher PSAV, shorter PSA doubling time and greater likelihood of PSA exceeding 1.0 ng/mL, overall postoperative PSA trajectories were statistically comparable between groups. These findings provide a reference for expected PSA kinetics after HoLEP in men with low-risk PCa undergoing active surveillance.