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PSA rising years later: what we do
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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.