PSA dropped after TURP surgery

I had to have TURP surgery after a urinary blockage caused by enlarged prostate caused urine to back up to my kidneys.

My kidneys were enlarged and damaged, and my eGFR (% of kidney function) had dropped to 26%.

A nephrologist did an ultrasound to diagnose this.

TURP surgery reversed the problem and my last eGFR was 46.
I'm hoping that improves more.

One thing that was interesting was my PSA dropped from around 3.5 to 1.6.
My urologist seemed happy, but not surprised at this.

I wonder if that has any bearing on my Gleason 6 PC?

Hi Tom, I hope your kidney function returns to normal soon! I, too, had a (very successful) TURP when my BPH got to be too much for the finasteride and tamulosin to overcome.

As you might suspect, it's mainly the inner prostate tissue (central zone) that is removed in a TURP. This extra, inward growth caused by the BPH is putting pressure on the urethra that causes it to narrow and sometimes, as in your case, occlude it, resulting in acute urinary retention. PCa lesions, however, more often form in the outer ring (periferal zone) of prostate tissue.

PSA, which is produced by both benign and malignant prostate tissue, is expected to go down after a TURP. My prostate was a whopping 90 cc at the time my TURP brought it down to 30 CC (there was a PSA drop, but I don't remember how much). Four years later, at the time of my RP, my prostate had grown back to 64 cc. My uro/surgeon said that some men will need a second procedure of some kind for BPH at some point-- that most likely would have included me had it not been for the cancer. After my TURP I was able to extinguish small forest fires.

BTW, your doc should get a pathology report back: the tissue removed in a TURP is always examined for cancer, although, as mentioned, it's not a representative sampling of all prostate zones as a biopsy is. You want to make sure that any lesions that are found haven't progressed in Gleason score. My TURP path exam was negative for cancer, as were all the many negative biopsies I had over the years until my positive biopsy. What I would have given to know back then that I would get PCa--I could have solved both problems with a single surgery!

I wouldn't read very much into PSA numbers before and after a TURP vis-a-vis your PCa, but you can certainly discuss this with your doc.

Best of luck to you!

The prostate, whether normal or cancerous, produces PSA. A larger prostate produces more PSA, in both normal and cancerous prostates. If a surgeon removes the entire prostate, PSA is expected to become zero, or very close to it. If he removes part of the prostate, as in a TURP, the PSA will almost certainly drop. Whether or not cancer is present. Although, it is quite possible that part of the cancerous tissue was removed along with the enlarged but otherwise healthy tissue.
So, a decreasing PSA after TURP does not really give you much useful info regarding any PCa you might have. It is to be expected either way. What counts now is if the PSA keeps on rising after the surgery, and at what rate. And of course, what future biopsies might show. Good luck!
Bill