What causes PSA levels to increase after prostate removal due to prostate gland enlargement (benign prostatic hyperplasia)?

Answers from Todd B. Nippoldt, M.D.

Increased levels of prostate-specific antigen (PSA) in your blood can be a sign of prostate cancer. However, cancer is just one of several possible causes of increased PSA.

Prostate tissue normally releases small amounts of PSA into your blood. When the prostate grows, PSA levels increase. When the entire prostate is removed, PSA levels fall close to zero. Most procedures used to treat an enlarged prostate remove only part of the prostate, which partially decreases PSA levels. After any enlarged prostate procedure, a number of factors can cause PSA levels to go up again. For example:

  • Prostate cancer. Prostate cancer cells in remaining prostate tissue or in other parts of your body can release PSA.
  • Recurrent benign prostate growth. Remaining prostate tissue might continue to grow, leading to increased PSA levels.
  • Inflammation of prostate tissue (prostatitis). Infection or inflammation of the prostate gland or remaining prostate tissue can cause your PSA levels to increase.

If you have increasing PSA levels after surgery for enlarged prostate, your doctor might recommend:

  • A wait-and-see approach. He or she might advise you to retake the PSA test.
  • Medication. If your doctor suspects prostatitis, you might be prescribed certain medications to cure the infection.
  • Additional tests. If a second test shows high PSA levels, your doctor might recommend imaging of the prostate with ultrasound, CT scan or magnetic resonance imaging (MRI). If cancer is suspected, you might need a biopsy to check remaining prostate tissue.
Feb. 18, 2015 See more Expert Answers