Many middle-aged and older men are diagnosed with elevated PSA levels during routine health checkups. PSA stands for prostate-specific antigen, a protein produced by the prostate gland. Measuring the concentration of PSA in the blood is an important indicator used to evaluate possible abnormalities in the prostate.
In general, a PSA level above 4.0 is considered an indication that further evaluation may be necessary. Elevated PSA levels may be associated with conditions such as benign prostatic hyperplasia (BPH), prostatitis, or prostate cancer. However, a high PSA level does not necessarily mean that cancer is present. In many middle-aged and older men, the most common cause of elevated PSA is benign prostatic hyperplasia.
BPH is a condition in which prostate tissue enlarges and compresses the urethra, leading to urinary difficulties. It is a very common condition, affecting more than half of men over the age of 50. The prevalence increases further among men in their 60s and 70s. As the prostate enlarges, symptoms such as a weak urinary stream, frequent urination, and waking multiple times during the night to urinate may occur. If these symptoms are left untreated, complications such as decreased bladder function, urinary tract infection, and kidney dysfunction may develop.
In the early stages of BPH, medication is usually the first line of treatment. Commonly prescribed medications include alpha-blockers and 5-alpha-reductase inhibitors. These drugs help relax the muscles of the prostate and bladder neck or reduce prostate size, thereby improving urinary flow. However, medication must be taken consistently to maintain its effectiveness. In some cases, the benefits of medication may be limited, or patients may experience side effects that make long-term treatment difficult. In addition, as time passes, the effectiveness of medication may decrease or the prostate may continue to enlarge, making surgical treatment necessary.
According to Dr. Jo Jung-ho of Goldman Urology Clinic’s Gangnam branch, one of the primary surgical options considered in such cases is holmium laser enucleation of the prostate (HoLEP).
HoLEP is a modern laser surgical procedure that uses a high-powered holmium laser to completely remove enlarged prostate tissue. The procedure is performed using an endoscopic, minimally invasive approach rather than open surgery or electrocautery techniques. One of its key advantages is that it causes less bleeding, allows faster recovery, and has a lower recurrence rate compared with traditional surgical methods. Because the prostate tissue is removed entirely, the tissue can also be examined through pathological testing to determine whether cancer is present.
HoLEP has gained particular attention because of its strong treatment outcomes and relatively low rate of complications. Dr. Jo explained that the use of a high-powered laser reduces bleeding while allowing the complete removal of enlarged prostate tissue, which lowers the likelihood of requiring repeat surgery. He also noted that many patients can be discharged on the same day after the procedure. In addition, HoLEP can be safely performed even in cases of extremely large prostates weighing more than 150 grams, making it suitable for complex or high-risk cases.
Dr. Jo emphasized that an elevated PSA level may be a sign of an underlying prostate condition, making accurate diagnosis and timely management essential. He added that when medication shows limited effectiveness, laser-based surgical options such as HoLEP should be considered. Since prostate health plays an important role in overall male health, seeking medical evaluation and receiving appropriate treatment at an early stage is the most prudent approach.