Purpose: This study investigated functional outcomes in lower urinary tract symptoms (LUTS), the incidence of incidental prostate cancer (PCa), and changes in prostate-specific antigen (PSA) levels after holmium laser enucleation of the prostate (HoLEP) in patients with elevated PSA and benign prostatic hyperplasia (BPH).Methods: A retrospective review of a prospectively designed protocol for patients who underwent HoLEP at our institution from January 2010 to May 2020 was conducted. Patients were classified into low-PSA (<3.0 ng/mL) and high-PSA (≥3.0 ng/mL) groups at baseline. Follow-up for PSA was performed at the sixth postoperative month. Baseline and postoperative clinical parameters, functional parameters, PCa incidence, and postoperative changes in PSA were compared between the lowand high-PSA groups.Results: The baseline PSA of 1,296 patients (mean age, 69.7±6.8 years) was 4.0±4.1 ng/mL, with 712 patients (55.0%) in the low-PSA group (1.6±0.8 ng/mL), and 584 patients (45.0%) in the high-PSA group (6.9±4.7 ng/mL). Incidental PCa was detected in 82 patients (6.3%), with a similar incidence in the low-PSA (41 patients, 5.9%) and high-PSA (41 patients, 7.0%) groups (P>0.05). At 6 months postoperatively, both groups showed significant improvements in the maximum flow rate, postvoid residual volume, and all domains of the International Prostate Symptom Score (P<0.05). At postoperative 6 months, the PSA level significantly decreased by 66.6%±23.6% in all patients (54.3%±23.9% in the low-PSA group; 79.6%±14.7% in the high-PSA group) (P<0.05), and the PSA levels of 1,264 patients (97.6%) had normalized.Conclusions: In patients with elevated PSA presenting with LUTS/BPH, our study demonstrated significant improvements in functional parameters and decreased PSA after HoLEP. The incidental PCa detection rate did not show a statistically significant difference between the low- and high-PSA groups. Timely surgery for LUTS/BPH without delay due to PSA monitoring should be considered.

Objectives To understand the natural history of patients with prostate specific antigen (PSA) elevation receiving Holmium Laser Enucleation of the Prostate (HoLEP) for benign prostatic hyperplasia (BPH), and to understand clinical factors correlated with PSA elevation. Subjects and Methods: Patients in the prospective database registry from our institution who underwent HoLEP between January 2010 and May 2020 were analyzed. The patients were classified into low (< 3.0ng/mL) and high ( > = 3.0ng/mL) PSA groups at baseline. Intraoperative and early postoperative outcomes were evaluated. Postoperative evaluation was performed, with PSA being evaluated at the postoperative sixth month. Factors showing correlation with PSA elevation were analyzed. Results A total of 1297 patients with a mean age of 69.7 (± 6.8 SD) years were analyzed. The baseline PSA was 4.0 (± 4.2) ng/mL, with 713 (55.0%) patients in the low PSA group (1.6 (± 0.8) ng/mL), and 584 (45.0%) patients in the high PSA group (6.9 (± 4.7) ng/mL). The PSA level decreased postoperatively by 66.6 (± 23.6)% in all patients, and 54.3 (± 23.9)% in the low PSA group, and 79.6 (± 14.7)% in the high PSA group. Conclusions In patients with LUTS and elevated PSA, significant PSA reduction and symptom improvement was observed after HoLEP.