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

Answer From Patricio C. Gargollo, M.D.

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

Prostate tissue typically 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, including:

  • 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 an enlarged prostate, your health care provider might recommend:

  • A wait-and-see approach. You might need to retake the PSA test.
  • Medication. If your provider suspects prostatitis, you might take certain medications to cure the infection.
  • Additional tests. If a second test shows high PSA levels, your provider might recommend an imaging exam of the prostate with ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). If cancer is suspected, you might need a biopsy to check remaining prostate tissue.


Patricio C. Gargollo, M.D.

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Dec. 20, 2022 See more Expert Answers