- With Mayo Clinic urologist
Erik Castle, M.D.
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Erik Castle, M.D.
Erik Castle, M.D.
Dr. Erik Castle is a board-certified urologist who joined the Mayo Clinic staff in Arizona in 2007.
Dr. Castle is an associate professor of urology at College of Medicine, Mayo Clinic, and a senior associate consultant in the Department of Urology, where he also is assistant residency coordinator.
He was an assistant professor in the Department of Urology at Tulane University in New Orleans from 2004 to 2006 after serving as a clinical instructor/fellow at Mayo Clinic in Arizona for one year.
Dr. Castle's research interests include prostate cancer, bladder cancer and kidney cancer. He is the director of the Desert Mountain Prostate Cancer Research Fund and is the principal investigator of Castle labs housed at the Samuel C. Johnson Medical Research building at Mayo Clinic in Arizona. His basic science research is focused on novel secondary hormonal therapies of prostate cancer as well as genomics of prostate and bladder cancer.
His surgical expertise includes laparoscopic urology, robot-assisted radical prostatectomy with nerve sparing, robot-assisted radical cystectomy with neobladder, robot-assisted retroperitoneal lymph node dissection, robot-assisted partial nephrectomy and other robotic urologic oncology procedures. He has performed many of these procedures as demonstrations internationally. He is a member of the American Association of Clinical Urologists, the American Urological Association, the Endourological Society, and the Society of Laparoendoscopic Surgeons. He is president of the international Society of Urologic Robotic Surgeons. He is also the director of the international laparoscopic nephrectomy courses throughout Mexico on behalf of the American Urologic Association.
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Question
PSA levels: Can they rise after prostate removal?
What causes PSA levels to increase after prostate removal due to benign prostatic hyperplasia?
Answer
from Erik Castle, M.D.
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.
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