Prostate cancer screening following UroLift

Background: The prostatic urethral lift (UroLift) is a minimally invasive surgical procedure for benign prostatic hyperplasia (BPH) that preserves erectile and ejaculatory function, making it attractive to younger men. However, its impact on prostate-specific antigen (PSA) levels, crucial for prostate cancer screening, is not well understood. This study aimed to evaluate PSA trends following UroLift and assess changes in international prostate symptom scores (IPSS) and the effects of discontinuing 5-alpha reductase inhibitors (5-ARIs). Methods: We retrospectively analysed 201 patients who underwent UroLift at a single institution between March 2017 and December 2019. Patients with preoperative and postoperative PSA measurements were included. PSA levels were assessed at various time points postoperatively, and IPSS scores were evaluated for symptomatic changes. The influence of 5-ARI discontinuation on PSA levels was also examined. Statistical analyses were conducted using Wilcoxon signed-rank and McNemar’s tests, with p < 0.05 considered significant. Results: A statistically significant increase in median PSA was observed at 1–3 months (2.47 ng/mL, p = 0.003), 6 months (2.40 ng/mL, p = 0.001), 1 year (2.25 ng/mL, p < 0.001), and beyond 1 year (1.85 ng/mL, p < 0.001) post-UroLift, compared to the preoperative median of 1.60 ng/mL. IPSS scores improved significantly, with a median reduction of 11 points ( p < 0.001). Twenty-four percent of our cohort utilised a 5-ARI preoperatively and discontinued it postoperatively, potentially contributing to the PSA increase. No prostate cancer was detected in patients with suspicious PSA trends who underwent further evaluation. Conclusions: PSA levels increased slightly but significantly following UroLift, potentially influenced by 5-ARI discontinuation. Despite this rise, no cases of prostate cancer were identified. These findings underscore the need for continued PSA monitoring post-UroLift and suggest further research to clarify the clinical implications of these PSA trends.