Regarding localized
prostate cancer (PC), questions remain regarding which patients are appropriate candidates for
conservative management. Some localized PC was an incidental finding in patients who received transurethral resection of the prostate (
TURP) for urinary symptoms. It is known that
TURP usually affects the level of
prostate-specific antigen (PSA). In the present study, we examined whether changes in PSA levels after
TURP possess a predictive value for localized PC. We retrospectively reviewed the clinical data of 846 early-stage PC patients who underwent
TURP for urinary symptoms upon diagnosis at our hospital. Of 846 patients, 687 had
tumor involvement in
TURP specimens, and 362 had post-
TURP PSA assessment. Our data revealed that, in addition to low GS and PSA levels at diagnosis, ≤5%
tumor involvement in
TURP specimens, greater PSA reduction (≥68%) following
TURP, and post-
TURP PSA ≤ 4 were significantly associated with better progression-free survival (PFS). Survival analysis revealed that the addition of prostate-directed local
therapy significantly improved PFS in intermediate- and high-risk groups, but not in the low-risk group. Moreover, in the intermediate-risk group, local
therapy improved PFS only for patients who were associated with post-
TURP PSA > 4 ng/mL or <68% PSA reduction following
TURP. We also found that local
therapy had no obvious improvement in PFS for those with post-
TURP ≤ 4 ng/mL regardless of pre-
TURP PSA. In conclusion,
conservative management is considered for patients at low or intermediate risk who have greater PSA reduction following
TURP and low post-
TURP PSA. Therefore, the levels of PSA following
TURP might be helpful for risk stratification and the selection of patients for
conservative management.