ReviewProstate cancer and prostatic diseases2026
How does PSA change after water vapor therapy? A systematic review and meta-analysis.
Review in Prostate cancer and prostatic diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
13 authors.
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Abstract
introductionProstate-specific antigen (PSA) kinetics following minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia (BPH) remain incompletely characterized. Water vapor thermal therapy (Rezūm™) induces targeted tissue ablation and inflammatory remodeling, potentially affecting PSA levels over time. The aim of this review was to quantify PSA changes after Rezūm therapy and explore study-level correlates of PSA dynamics through a systematic review and meta-analysis.
methodsThis systematic review followed PRISMA guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched for studies reporting baseline and post-treatment PSA after Rezūm therapy. The primary outcome was pooled mean change in PSA (ΔPSA) versus baseline at prespecified timepoints (1, 3, 6, 12 months, and last follow-up). Random-effects models using restricted maximum likelihood (REML) were applied, with heterogeneity assessed using Cochrane Q. Meta-regression explored associations between ΔPSA and study-level variables, including acute urinary retention (AUR), reintervention rates, symptom and flow improvements, and prostate volume.
resultsThirteen studies were included. PSA followed a biphasic pattern. At 1 month, an early postoperative increase was observed (2 studies; ΔPSA = +2.38 ng/mL, 95% CI 1.62-3.14). From 3 months onward, PSA levels declined, reaching a moderate but non-statistically significant reduction at the last available follow-up (12 studies; ΔPSA = -0.44 ng/mL, 95% CI - 0.92 to 0.04), corresponding to an approximate 10% decrease from baseline. Meta-regression showed associations between ΔPSA and AUR (β = 0.0799, p = 0.034), reintervention rates (β = -0.226, p = 0.026), Qmax improvement (β = -0.0308, p = 0.028), baseline PSA (β = -0.536, p < 0.001), and baseline prostate volume (β = -0.0861, p = 0.002).
conclusionsRezūm therapy is associated with a reproducible PSA trajectory characterized by an early transient increase followed by a moderate decline from 3-12 months (~10%). Because this late change is non-significant and within the expected variability of PSA, it is unlikely to modify follow-up strategy. Awareness of this pattern may support appropriate interpretation of PSA measurements after MIST for BPH.
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Registered trials
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