Keep Factually independent
Whether you agree or disagree with our analysis, these conversations matter for democracy. We don't take money from political groups - even a $5 donation helps us keep it that way.
Fact check: What is the average PSA level after prostate cancer surgery?
Executive Summary
After prostate cancer surgery, clinicians generally expect prostate-specific antigen (PSA) to fall to very low or undetectable levels, but reported “average” values vary with assay sensitivity, surgery type and whether the operation was primary or salvage. Contemporary surgical series report ultrasensitive last-follow-up PSA commonly below 0.01 ng/mL for durable responders, while other studies and simple prostatectomy cohorts report early postoperative means in the 0.7–1.7 ng/mL range or persistent PSA in a substantial minority, highlighting clinical heterogeneity and the need to interpret averages in context [1] [2] [3] [4].
1. What claim were people making and what did the evidence actually say?
The set of source analyses asserts varied claims: that persistent PSA predicts worse outcomes after salvage radical prostatectomy, that initial postoperative PSA differs between benign and cancerous prostates, and that some series report undetectable PSA long-term after radical prostatectomy. The October 2023 multicenter salvage series documented persistent PSA in 42% of patients, linking persistence with worse oncologic metrics and higher preoperative PSA [4]. A January 2025 study reported initial postoperative PSA of 0.76 ng/mL in benign specimens versus 1.68 ng/mL in cancers after simple prostatectomy [2]. Older and heterogeneous series report postoperative values ranging broadly, from undetectable (<0.01 ng/mL) in long-term cures to 0.1–3.0 ng/mL in selected cohorts [1] [3].
2. Why “average PSA” is a misleading question unless you define the context
“Average” PSA after surgery conflates different clinical states. Primary radical prostatectomy aims to remove all prostate tissue, so the expected PSA is often undetectable by ultrasensitive assays (<0.01–0.1 ng/mL), whereas **simple prostatectomy** (for benign disease or debulking) leaves residual tissue producing measurable PSA, producing higher postoperative averages [1] [2]. Salvage prostatectomy after prior treatments shows a higher rate of persistent PSA and worse outcomes, so averages there are shifted upward [4]. Timepoint, assay lower limit, and patient selection change any calculated mean substantially.
3. The most consistent contemporary finding: ultrasensitive undetectable PSA in cured patients
Large institutional series show that when radical prostatectomy removes cancer effectively, long-term follow-up often documents PSA values below assay limits—commonly <0.01 ng/mL—associated with excellent biochemical recurrence (BCR)-free survival. A 2016 cohort analyzing ultrasensitive PSA found last-follow-up PSAs generally <0.01 ng/mL among patients with durable undetectable values and 100% 10- and 15-year BCR-free survival for those with sustained undetectable levels [1]. This suggests that for primary, successful radical prostatectomy, the practical “average” among cured patients is near zero on ultrasensitive testing.
4. Studies showing higher early postoperative PSA and what they mean for interpretation
Not all series report near-zero averages. A 2025 simple prostatectomy analysis found initial postoperative PSA values of 0.76 ng/mL (benign) and 1.68 ng/mL (cancer), reflecting residual glandular tissue and differing indications for the surgery [2]. An older 2002 study described 15 patients with PSA between 0.1 and 3.0 ng/mL after radical prostatectomy, underscoring selection bias and historical assay limitations [3]. These results demonstrate that mean PSA estimates depend heavily on surgical technique, indication and era, and averaging across mixed cohorts produces numbers of limited clinical use.
5. Salvage surgery and persistent PSA: a large minority with measurable PSA post-op
Salvage radical prostatectomy—performed after failed prior local therapy—shows a markedly different PSA profile. A multicenter 2023 study found 42% of patients had persistent PSA after salvage prostatectomy, and persistence correlated with higher preoperative PSA and positive margins, predicting worse oncologic outcomes [4]. This indicates that in salvage cohorts the average postoperative PSA is meaningfully higher than in primary surgery cohorts, and that persistent measurable PSA post-surgery is a clinically important predictor rather than a benign statistical artifact.
6. Practical clinical thresholds clinicians use to define recurrence and guide follow-up
Clinicians treat PSA not by average values but by thresholds and kinetics. Historically, PSA ≥0.2 ng/mL after radical prostatectomy is frequently used to define biochemical recurrence, while ultrasensitive assays and PSA kinetics inform earlier concern and surveillance intensity. Studies recommending follow-up schedules emphasize shorter intervals in the first year to detect rising PSA before it crosses recurrence thresholds, adjusting frequency thereafter based on risk and PSA velocity [5]. Therefore, absolute averages are less useful than individual trajectories and pre-specified cutoffs.
7. Bottom line: how to answer “what is average PSA after surgery?” for a patient or clinician
The most defensible short answer is that for primary radical prostatectomy the expected PSA is undetectable on modern ultrasensitive assays (often <0.01 ng/mL) in patients with durable disease control, while simple prostatectomy and salvage cases commonly show higher early postoperative means (0.7–1.7 ng/mL or measurable persistent PSA in ≈42% of salvage series) [1] [2] [4] [3]. Clinicians should interpret any reported “average” through the lens of assay sensitivity, surgery type, timing and patient selection, and prioritize individual thresholds and PSA dynamics over population averages [5] [6].