Prostatic Diseases and Male Voiding Dysfunction Prostatic-speciﬁc Antigen Velocity After Holmium Laser Enucleation of the Prostate: Possible Predictor for the Assessment of Treatment Effect Durability for Benign Prostatic Hyperplasia and Detection of Malignancy Hazem M. Elmansy, Ehab A. Elzayat, John S. Sampalis, and Mostafa M. Elhilali OBJECTIVES To evaluate the prostate-speciﬁc antigen velocity (PSAV) as an indicator for effectiveness and durability of size reduction after holmium laser enucleation of the prostate (HoLEP). Addition- ally, PSAV monitoring in the detection of prostate cancer was also evaluated. METHODS Between 1998 and 2006, we reviewed the prostate-speciﬁc antigen (PSA) data of 335 men who underwent HoLEP and had a complete PSA data including preoperative PSA, postoperative PSA (reset), and a minimum of 2 annual PSA readings after PSA reset. PSAV was calculated by 3 methods—simple arithmetic method, linear regression method, and rate method. RESULTS In the benign group, the mean PSA dropped from 5.44 to 0.91 ng/mL (P 0.001). The prostate cancer patients who were newly discovered in the follow-up period had signiﬁcantly higher baseline PSA (P = .032) and signiﬁcantly lower PSA reduction than that of the benign group (75.39% vs 47.49%, P .001). PSAV was calculated by 3 different methods and produced identical results; however, linear regression method produced signiﬁcantly lower estimates at 7 years. In the malignant group, the mean PSAV at 1 and 3 years was higher than that of the benign group (1.28 vs 0.13 and 2.4 vs 0.09, P 0.022, 0.001, respectively). CONCLUSIONS HoLEP results in a signiﬁcant reduction in PSA that remained at lower levels during follow-up, suggesting that the glandular size reduction after HoLEP is durable. Monitoring of PSAV is important in long-term follow-up of patients for prostatic carcinoma detection after prostatic surgery. UROLOGY 74: 1105–1110, 2009. © 2009 Elsevier Inc. H olmium laser enucleation of the prostate (HoLEP) is one of the most investigated laser procedures for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). It can be used safely in high surgical risk patients with no size limits of the treated prostate, as it is suitable for small-to-moderate size prostates as well as larger glands. 1 HoLEP seems to be a suitable endourologic alternative to open prostatectomy. 2 The Holmium: Yttrium-aluminum-garnet (Ho: YAG) la- ser (Versa Pulse; Lumenis Inc., Santa Clara, CA) allows precise removal of obstructing prostatic tissue with a hemostatic effect that limits bleeding during resection. 3 HoLEP produces sustained improvement of objective and subjective outcomes. The procedure is safe and effective with low morbidity, short catheterization time, and du- ration of hospitalization. 4 The HoLEP technique has been shown to produce signiﬁcant reductions in prostate-speciﬁc antigen (PSA), which correlates with the amount of prostate tissue re- moval. As PSA reduction is similar to that achieved with open prostatectomy, HoLEP can be considered the min- imally invasive technique with maximal tissue removal. 5 After treatment, the PSA levels are reduced to new lower levels (reset) that should be sustained during fol- low-up of the patient with BPH. Increases in the PSA levels even within the normal range would indicate pros- tate biopsy as this is associated with an increased risk for From the Divisions of Urology, and Surgical Research, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada Reprint requests: Mostafa M. Elhilali, M.D., F.R.C.S.(C), Ph.D., Urology Divi- sion, Department of Surgery, Royal Victoria Hospital, MUHC, 687 Pine Ave W, Room S6.95, Montreal, Quebec, H3A 1A1 Canada. E-mail: mostafa.elhilali@muhc. mcgill.ca Submitted: March 10, 2009, accepted (with revisions): June 13, 2009 © 2009 Elsevier Inc. 0090-4295/09/$34.00 1105 All Rights Reserved doi:10.1016/j.urology.2009.06.039