Postoperative prostate-specific antigen kinetics after holmium laser enucleation of the prostate in men with low-risk prostate cancer.

Objectives: To characterize postoperative prostate-specific antigen (PSA) kinetics after holmium laser enucleation of the prostate (HoLEP) in men with low-risk prostate cancer (PCa) managed with active surveillance and to compare these with men without PCa, establishing a benchmark for expected PSA behaviour after HoLEP in low-risk disease. Patients and Methods: We retrospectively reviewed a prospectively maintained HoLEP database at a tertiary centre from 2017 to 2025. Patients were stratified into benign and low-risk PCa cohorts, with low-risk PCa defined as Grade Group 1 disease. Patients with clinically significant PCa were excluded. PSA values were assessed at standardized postoperative time points up to 5 years. PSA reduction, PSA velocity (PSAV), PSA doubling time and surveillance outcomes were compared between groups. Results: A total of 769 patients were included (692 benign, 77 low-risk PCa). Baseline characteristics were broadly comparable. Both groups demonstrated marked and similar PSA reductions after HoLEP, with no significant difference in percent PSA decline from baseline (91.6% vs. 91.1%, Conclusion: HoLEP produces a substantial PSA 'reset' with sustained low postoperative PSA in both benign and low-risk PCa patients. Although low-risk patients showed numerically higher PSAV, shorter PSA doubling time and greater likelihood of PSA exceeding 1.0 ng/mL, overall postoperative PSA trajectories were statistically comparable between groups. These findings provide a reference for expected PSA kinetics after HoLEP in men with low-risk PCa undergoing active surveillance.