以術後PSA變化量評估攝護腺雷射手術效果

陳柏佑,李允仁,侯鎮邦,林友翔,楊佩珊,張慧朗,陳建綸,崔克宏

林口長庚醫院外科部泌尿科

Post-Operative Change of PSA as an Outcome Predictor in BPH Patients Receiving Transurethral Laser Surgery

Po-You Chen, Yun-Ren Li, Chen-Pang Hou, Yu-Hsiang Lin, Pei-Shan Yang, Phei-Lang Chang, Chien-Lun Chen, and Ke-Hung Tsui

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

Purpose:

To discover the predictive factors for the efficacy of transurethral laser surgery for benign prostatic hyperplasia (BPH)

Patient and Method:

We collected a total of 135 patients diagnosed with BPH who underwent transurethral thulium laser enucleation of the prostate (ThuLEP). All patients were excluded from prostatic malignancy before the operation, and cases of prostatic malignancy found during post-operative follow-up period were also excluded. The subjective and objective parameters for lower urinary tract symptoms (LUTS), including prostatic-specific antigen (PSA), International Prostate Symptom Score (IPSS), quality of life (QoL), peak flow rate (PFR) and residual urine (RU), were recorded at pre- and post-operative time points. The difference between LUTS parameters before and after surgery were calculated to assess the parameters’ degree of improvement by the operation. Descriptive statistics and correlation analysis were utilized to explore the relationship between the change of PSA at the third month after surgery and the change of long-term IPSS, QoL, PFR, and RU.

Result:

The preoperative value of PSA was positively correlated with patient age and prostate volume. The preoperative value of IPSS and QoL were positively correlated with disease duration of BPH, and QoL was negatively correlated with PSA, while both parameters were not correlated with patient age or prostate volume. The preoperative value of RU was positively correlated with prostate volume and PSA. PFR was not correlated with any underlying factors. After surgery, the change in IPSS at any time points was not correlated with the change in PSA at the 3^rd month after surgery. The change in QoL at the 15^th month after surgery were positively correlated with the change in PSA at the 3^rd month after surgery (P= .047). The change in PFR at the 27^th month after surgery were positively correlated with the change in PSA at the 3^rd month after surgery (P= .040). The change in RU at the 15^th, 33^th, and 39^th months after surgery was positively correlated with the change in PSA at the 3^rd month after surgery (P= .009, P= .033, and P= .003, respectively). Re-operation rate (due to urethral stricture, bladder neck stricture or check bleeding) was not correlated with patient age, prostate volume, or LUTS severity. Re-medication rate was positively correlated with patient age (P= .013), but was not correlated with prostate volume, or LUTS severity

Conclusion:

In transurethral thulium laser enucleation of BPH, the long-term outcome of IPSS cannot be predicted by the change of PSA. QoL and PFR can weakly be predicted by PSA, while long-term post-operative RU could strongly be predicted by PSA at the third month after surgery.