Initial Postoperative Prostate Specific Antigen and PSA Velocity are Important Indicators of Underlying Malignancy after Simple Prostatectomy.

BACKGROUND There is a paucity of guidelines for prostate specific antigen monitoring after simple prostatectomy despite these patients remaining at risk for prostate cancer. Our objective was to determine if PSA kinetics can be a potential indicator of prostate cancer after simple prostatectomy. METHODS A retrospective review was performed of all simple prostatectomies at our institution from 2014-2022. All patients who met criteria were included in the study. Relevant clinical variables were collected preoperatively, including prostate specific antigen (PSA), prostate size, and voiding symptoms. Surgical and urinary function outcomes were analyzed. RESULTS A total of 92 patients were divided into two groups based on malignancy status. Sixty-eight patients had no diagnosis of prostate cancer, while 24 patients had known prostate cancer prior to surgery (14) or were diagnosed with incidental prostate cancer from pathologic specimen (10). Patients with benign prostates had an initial postoperative PSA of 0.76 ng/mL compared to 1.68 ng/mL for those with cancer (p < 0.01). PSA velocity for the first 24-months after surgery was 0.042 +/- 1.61 ng/mL/year for the benign cohort compared to 1.29 +/- 1.02 ng/mL/year for the malignant cohort (p = 0.01). Voiding improvements were noted by objective (post-void residual, flow rate) and subjective (American Urologic Association symptom score and quality of life score) measures in both groups. CONCLUSION PSA interpretation and monitoring after simple prostatectomy has not been well-established. Our study indicates that initial postoperative PSA value as well as PSA velocity are important indicators of underlying malignancy for patients after simple prostatectomy. Further efforts are needed to establish threshold values and formal guidelines.