Prostate-Specific Antigen, or PSA, is a protein made by cells in the prostate gland, which is a small gland located below the bladder in males. Both healthy and cancerous prostate cells produce PSA. The PSA test measures the amount of this protein in the bloodstream.
Transurethral Resection of the Prostate (TURP) is a surgical procedure commonly used to alleviate urinary symptoms caused by an enlarged prostate, a non-cancerous condition known as benign prostatic hyperplasia (BPH). During a TURP, a surgeon inserts a slender instrument through the urethra to remove excess prostate tissue that is blocking urine flow. Monitoring PSA levels before and after this procedure is a standard practice in patient care.
Expected PSA Levels After TURP
Following a Transurethral Resection of the Prostate (TURP), a notable reduction in PSA levels is expected. This occurs because the procedure removes PSA-producing prostate tissue. PSA levels correlate with the volume of prostate tissue.
The initial drop in PSA levels is significant, with studies indicating an approximate 71-72% decrease from pre-surgery baseline levels. The TURP primarily removes tissue from the transition zone, an area producing a higher amount of PSA. This new, lower baseline PSA level usually stabilizes within several weeks to two months post-procedure.
While a substantial amount of prostate tissue is removed, some prostate tissue remains. This remaining tissue will continue to produce a small amount of PSA, meaning levels will not drop to zero as they might after a complete prostatectomy. For instance, a median PSA of about 0.6 ng/mL has been observed after 48 months. This new, lower PSA level becomes the reference point for future monitoring.
Interpreting PSA Trends Post-TURP
After the initial post-TURP drop and the establishment of a new, lower PSA baseline, ongoing monitoring focuses on the trend of these levels over time. A rising PSA level from this new baseline can signal the regrowth of benign prostatic tissue, a condition known as BPH recurrence.
A sustained rise in PSA may suggest prostate cancer presence or recurrence, whether undetected before surgery or developed afterward. While a single, slight elevation might be a temporary fluctuation, a consistent increase across multiple tests can be a cause for concern. Such a trend necessitates prompt medical evaluation, potentially including repeat PSA tests, a digital rectal exam, and a prostate biopsy.
The rate at which PSA levels rise, known as PSA doubling time, can indicate the aggressiveness of any potential recurrence; faster doubling times suggest more aggressive disease. For example, a PSA doubling time of less than three months may signal aggressive disease, whereas doubling times over 12 months are associated with lower-grade recurrences. Understanding these trends is an important part of long-term patient management after TURP.
Factors Influencing PSA Beyond TURP
Beyond TURP and potential prostate cancer, various other factors can influence PSA levels, leading to temporary fluctuations. Prostate infections (prostatitis) or urinary tract infections (UTIs) can cause PSA levels to rise due to inflammation. These increases are usually temporary, resolving once the infection is treated.
Recent medical procedures or physical activities can affect PSA readings. A digital rectal exam, catheterization, or even vigorous exercise like cycling can temporarily elevate PSA levels. Avoiding such activities for at least 48 hours before a PSA test is often recommended for accurate results.
Certain medications, like 5-alpha reductase inhibitors (e.g., finasteride or dutasteride) used for BPH, can lower PSA levels. If a patient begins these medications after TURP, their PSA levels may appear lower, potentially masking a rising trend that could indicate cancer. Age also influences PSA levels, as the prostate naturally enlarges, leading to higher PSA values. Discussing all PSA results and individual circumstances with a healthcare provider is important for accurate interpretation.