Role of Prostate Specific Antigen and Prostate Specific Antigen Density as Biomarkers for Medical and Surgical Treatment Response in Men With Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis

Introduction: Prostate specific antigen and Prostate specific antigen-density are used for the initial evaluation of patient with LUTS due to benign prostatic enlargement in order to discriminate between benign conditions and prostate cancer. Conversely, the role of these markers during the follow up of benign prostatic enlargement patients is still unclear. The aim of our study is to evaluate the role of PSA and PSAD as outcome parameter for both medical and surgical treatment in patients with male LUTS. Evidence acquisition: We performed a systematic review and meta-analysis based on data from clinical trials evaluating the clinical effect of medical or surgical therapy on LUTS/BPE. Meta-regression analyses were done to evaluate the effects of several factors on IPSS score improvement. Evidence synthesis: We selected 12 studies out of 433, including data on 1959 patients. Both medical and surgical treatment lead to a significant reduction of PSA levels as compared to baseline (p<0.001). However, after medical treatment, lower PSA values are associated with more significant improvements in lower urinary tract symptoms as measured with the IPSS, while after surgery (p<0.05), the recovery of urinary function does not correlate with the decline in PSA values (p=0.59). After medical treatment, the improvement in LUTS correlate with a decline of PSAD, while the opposite holds true in men treated with surgery (both: p<0.001). Conclusions: PSAD may represent an objective treatment outcome parameter and should be evaluated during the follow up of men treated for LUTS due to BPE as marker of treatment response