Postoperative prostate‐specific antigen kinetics after holmium laser enucleation of the prostate in men with low‐risk prostate cancer
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 ShahAbstract
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.