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PSA after TURP
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PSA after TURP

I am a white male,57, in good health except for prostate BPH, with no family history of prosate problems. My questions pertain to expected PSA levels after TURP.
Some background: I have had prostate problems for 25 years, starting with chronic prostatitis and diagnosed with BPH 10 years ago, with a PSA of 6.8. Cystoscopy,transrectal ultrasound and biopsy showed no cancer. From then until Feb of '04 I tried numerous medications which did not seem to help while I practiced 'watchfull waiting'. PSA testing was done every 6 to 12 months and bounced between 5.9 and 11.6; there were 2 more rounds of scoping and biopsy which showed the prostate to be about 35 to 40 grams, with no cancer.
By this time I was having increased difficulty starting urination, having to urinate frequently, and was retaining almost 1 liter of urine. I had a Foley catheter installed for 6 weeks while my bladder deflated. In late April '04 I had a TURP where about 38 grams was sent for biopsy, with no sign of cancer. I never got a strong urine flow, and 9 weeks after the TURP went into total urine retention due to bladder neck scarring. The scarring was so severe the urologist could not insert a cystoscope or catheter so a suprapubic catheter was installed. I had a second operation a week later (late June '04) were the urologist had to cut into the bladder and working from both inside the bladder and penis opened the channel.
I was not scheduled to see the urologist until Feb '05 but himin in mid Nov '04 as I noted urine stream flow was decreasing. He put me on .4mg of FloMax which helped. In Dec '04 as part of a physical exam at work I had a PSA result of 7.19. The physician at work felt this was quite high considering the TURP and recommended I contact my urologist. I did not speak with him directly but received informaion back from his nurse that he considerered this 'normal'. Even with the Flomax, my urine flow is starting to decrease so I have scheduled to see him again in 2 weeks, and had blood drawn for a PSA test today in preparation for that exam.

I am concerned that since the first TURP, other than the attempted cystocopy of June '04 when I had total urinary blockage, and this PSA test there has been no testing to determine what's happening.

What should PSA run post TURP and what course of action should be followed if it is 'high'?
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It may be possible that the PSA may be caused from prostatic tissue that may have been left after the TURP.  If there was leftover tissue, things like infection can also lead to an elevation of PSA.

I would repeat the test to ensure that the PSA is indeed elevated.  A repeat transrectal ultrasound can be considered to image the area where the TURP took place.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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