PSA levels: Can they rise after prostate removal?

What causes PSA levels to increase after prostate removal due to benign prostatic hyperplasia?

- Walter / Ohio

Mayo Clinic urologist Erik Castle, M.D., and colleagues answer select questions from readers.

Answer

Prostate surgery is one treatment for noncancerous prostate gland enlargement (benign prostatic hyperplasia, or BPH). The surgery reduces the amount of prostate tissue around your urethra by removing some — but not all — of your prostate. Following surgery, it's possible for the prostate gland to regrow, which can cause an increase in prostate-specific antigen (PSA) levels. You may also experience elevated PSA levels if not enough of your prostate is removed.

In addition, elevated PSA levels can indicate:

Inflammation of the prostate (prostatitis). Infection or inflammation of the prostate gland can cause your PSA levels to increase. Once prostatitis is treated with antibiotics, PSA levels should return to normal.
Recurrent BPH. Despite prostate surgery, BPH can recur and cause your PSA levels to increase. Some men may need a second surgery after a number of years.
Prostate cancer. Prostate cancer cells — in your prostate or in other parts of your body — may be secreting PSA.
Recent ejaculation. Recent ejaculation can cause a temporary increase in PSA levels. In order to get the most accurate reading, you should avoid ejaculation for two days before undergoing a PSA test.

Sometimes an elevated PSA reading doesn't indicate a problem. It's possible for adult men with healthy prostates to have higher than normal PSA levels. In fact, PSA levels normally increase in all men as they age. It's important that PSA levels be interpreted by a doctor experienced in prostate disease.

If you have elevated PSA levels after prostate surgery, your doctor may recommend a wait-and-see approach — advising you to retake the PSA test after two or three months. If your doctor suspects prostatitis, you may be prescribed antibiotics to cure the infection.

If a second PSA test shows high levels, your doctor may recommend other tests, such as urine tests, kidney or bladder ultrasounds, X-rays, or other imaging tests. If cancer is suspected, a prostate biopsy may be recommended.