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PSA after prostate surgery: what does your result mean?
Dr. Fernando Gómez Sancha · ICUA
Dr. Fernando Gómez Sancha · YouTube
Language: English. Editorial classification in the patient catalog.
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About this video
Have you had prostate surgery and are you worried about your PSA result? I’m Dr Fernando Gómez Sancha. In this video, I explain how to interpret this blood test after surgery for benign prostate enlargement.
We discuss the fall in PSA, the prostate tissue that remains and the importance of follow-up. I explain what it may mean if the level does not fall as expected or starts rising again, and why further investigation may be needed. A raised PSA alone does not establish a cancer diagnosis.
Your result needs to be considered alongside your individual circumstances, surgery and tissue analysis. Discuss it with your urologist.
Documented details and sources
Only details explicitly stated in the sources. Missing information does not mean it did not occur.
No clinical case details have been extracted for this video.
Original title and description on YouTubeSource checked: 2026-10-04.
Video moments
- PSA is not a cancer marker: it's a prostate marker
- PSA after HoLEP: how much and when does it drop?
- PSA that doesn't drop after surgery: what does it mean?
- PSA rising years later: what we do
- Hidden cancer in 5%: why we analyse the tissue
- PSA after prostate surgery: what does your result mean? · 0:01
- PSA after prostate surgery: what does your result mean? · 0:39
- PSA after prostate surgery: what does your result mean? · 1:25
- PSA after prostate surgery: what does your result mean? · 2:04
- PSA after prostate surgery: what does your result mean? · 2:51
- PSA after prostate surgery: what does your result mean? · 3:31
- PSA after prostate surgery: what does your result mean? · 4:20
Available transcript · English
Source: subtitles embedded in the published video.
They may contain transcription or translation errors; check the explanation in the video.
- Doctor, I've had prostate surgery and my PSA is still coming back high. Do I have cancer? This is a query I get often, and it causes a huge amount of anxiety. Today I'm going to explain what blood PSA levels mean after prostate surgery and when it's actually a cause for concern.
- I'm Doctor Fernando Gómez Sancha, I've been in urology for thirty-two years. I've operated on over ten thousand patients using prostate lasers and I've seen hundreds of patients distressed by a PSA they don't understand.
- Let's clear this up. First, what is PSA? PSA, prostate-specific antigen, is a protein produced in prostate tissue. Any prostate tissue. It's not a cancer marker, it's a prostate marker.
- That's vital to understand. After surgery for benign hyperplasia, whether it's laser enucleation, transurethral resection, or green laser vaporisation, what happens to the PSA? It should drop significantly.
- If before surgery you had a PSA with a normal value below four or above four, uhm, but it was considered a benign increase, after a laser enucleation, it's normal for it to drop to one or less than one.
- Why? Because we've removed most of the prostate tissue that was producing that PSA, releasing that PSA from the prostate glands into the bloodstream. How long does it take to drop?
- PSA doesn't drop overnight. It's usual to wait between six and eight weeks after surgery to get the first reliable reading. Before that, the values can be affected by the inflammation caused during the surgery itself.
- Now, there are some slightly worrying scenarios. First, the PSA drops a lot, but doesn't reach zero. This is normal. There's always some prostate tissue left. The prostate capsule is still there.
- A PSA from zero point two to one after surgery is perfectly acceptable. Second scenario: the PSA doesn't drop as expected. If after surgery the PSA stays above one, two, three, four, five, it needs investigating.
- It could mean residual tissue was left, which is rare with an experienced surgeon, or there could be a component of a cancer that was hidden. This is where pathological analysis of the tissue is important, and one of the reasons why I insist on techniques that allow the tissue to be analysed, like holmium laser enucleation, uhm, and not techniques that vaporise or destroy it.
- The third scenario: the PSA drops well after surgery, but months or years later it starts to rise again. This requires attention. It could be residual tissue growth, which is rare with HoLEP, but it could also indicate prostate cancer.
- There's no need to panic, but it does need to be looked into. What do I do with my patients? I request a PSA at six or eight weeks and then one annually. If the PSA remains stable and low, there's no cause for concern.
- If it rises, we investigate with the tools we have: an MRI and, if necessary, a biopsy. An important fact: in the analysis of the tissue we remove during enucleation, we find hidden cancer, incidental cancer, in about five percent of patients.
- These are cancers that we didn't know existed before the surgery. Most are usually low-grade and don't require immediate treatment, but detecting them is useful so that we can monitor them.
- This is another reason why it's important to analyse the tissue. My message is clear: the PSA after surgery is no reason to panic, but it is a monitoring tool that must be interpreted correctly.
- If, one, a, a, an interesting factor is that many general practitioners don't know how to interpret the PSA after an operation. Sometimes, the patient is followed by their GP and they see that the PSA is at levels of two, two and a half, three.
- Since they see it's below the normal value of four nanograms per millilitre in non-operated patients, they consider it normal. And that patient could have a prostate tumour and we're not doing anything.
- Don't self-diagnose with Google, talk to your urologist, who knows your case, your surgery, and your histology. If you have doubts about the PSA, you have the link to consult in the description.
- Subscribe and see you in the next video.