The Advantages of TURP in Patients with an Elevated/Rising PSA, Mild/Moderate LUTS, Bladder Outlet Obstruction and Negative Prostate Cancer Imaging/Prostate Biopsies. A Prospective Analysis in 105 Consecutive Patients

Aim: To investigate elevated/rising PSAas a marker for BOO (Bladder Outlet Obstruction) in patients with minor LUTS (Lower urinary tract Symptoms) and without prostate cancer. Methods: 105 Consecutive patients were prospectively analyzed between 2005 and 2013. All patients were referred to the principal investigator by their general practitioner as a result of an elevated and/or rising PSA. Only patients with minor LUTS (I-PSS (International Prostate Symptom Score) 0-19)) and without suspicion for prostate cancer were included. All patients had BOO, shown by full urodynamics, and underwent TURP. Resected tissue was histologically examined and PSA/IPSS were evaluated after 3, 6 and 12 months and later on yearly. Results: Mean pre-operative PSA- and I-PSS- values were 8.8 ng/mL and 11.1 respectively. The mean detrusor pressure at maximum flow was 93.6 cm H2O. The mean resected volume 52 g and the mean prostatebiopsyrate1.8. 83/105 patients (79%) had no malignancy and were diagnosed with BOO due to BPH (Benign Prostatic Hyperplasia) (subgroup 1). Their mean PSA decreased from 9.2to 0.7ng/ml and 0.9 ng/ml after 6 and 12 months post-op respectively. The mean IPSS declined from 11 to 3 after 6 months and12months. 16/105 patients (15%) were treated for prostate cancer (subgroup 2). Radical prostatectomy was performed in 11 patients, brachytherapy in 3 patients and external beam radiotherapy in 2 patients. 6/105 Patients (5.7%) had active surveillance (subgroup 3). Conclusion: BOO can cause an elevated/rising PSA in patients with minor LUTS and negative screening for prostate cancer. TURP is an adequate treatment for these patients. Core tip: Patients referred to the urologist because of an elevated/high PSA-value, are a common problem in the daily practice. After excluding prostate cancer or urinary tract infection, patients are reassured. But what has to be done when the PSA-level rises? Our hypothesis suggests that BOO (bladder outlet obstruction) can cause an elevated/high PSA in patients with minor LUTS (I-PSS 0-19) and negative findings for prostate cancer. We describe our findings in 105 consecutive, prospectively enrolled patients and also describe the benefits of a TURP in these patients.