How can prostatitis or urinary tract infection raise PSA after prostate removal?
Executive summary
Prostatitis and urinary tract infection (UTI) can cause measurable rises in prostate‑specific antigen (PSA) even after the prostate has been removed, primarily by causing inflammation or infection that increases PSA leakage from residual prostatic tissue, surgical margins, or non‑prostatic sources that can register on assays [1] [2] [3]. While a post‑prostatectomy PSA is expected to become undetectable within weeks to months, transient increases from infection or inflammation are well documented and often fall with appropriate antibiotic or anti‑inflammatory treatment—though any measurable PSA after prostatectomy still requires careful evaluation for recurrence [4] [5] [2] [6].
1. Why PSA should be (nearly) zero after prostate removal — and why clinicians still worry
After radical prostatectomy the goal is an undetectable PSA because the prostate gland is the main source of that protein; most guidelines and patient information state PSA should fall to very low or undetectable levels within weeks to a few months after surgery, and measurable values months later prompt concern for residual or recurrent cancer [4] [7] [5]. This baseline expectation is why any rise—even a small one—is treated seriously and investigated with repeat testing and imaging when appropriate [6] [8].
2. How inflammation from prostatitis raises PSA: the biological mechanism
Prostatitis, whether acute bacterial, chronic bacterial, or chronic inflammatory, inflames prostate tissue and disrupts epithelial barriers, allowing PSA that normally stays within glandular tissue to leak into the bloodstream and raise serum levels; multiple clinical studies show PSA falls after treating prostatitis with antibiotics and anti‑inflammatories, demonstrating inflammation‑driven PSA elevation is reversible [1] [9] [2]. Even in men without a full gland, small amounts of residual benign tissue at surgical margins or microscopic prostate cells can be inflamed and secrete PSA when infected or irritated [6] [2].
3. Why a UTI can also move the needle on post‑op PSA
A urinary tract infection can inflame the bladder, urethra, or residual prostatic tissue and indirectly increase PSA by the same leakage mechanism; clinical and patient‑facing sources list UTIs among causes of elevated PSA and recommend treating the infection and repeating the test because levels commonly fall after therapy [10] [11] [2]. Additionally, the urethra and other non‑prostatic tissues may contain PSA or PSA‑like proteins detectable in urine or, rarely, in serum—studies of urinary and urethral PSA after prostatectomy found measurable amounts coming from the urethra itself, complicating interpretation [3].
4. Distinguishing infection/inflammation from cancer recurrence in practice
Because prostatitis and UTI can transiently raise PSA, urologists often treat suspected infections and recheck PSA after antibiotics before concluding recurrence; studies show significant PSA declines after antibiotics in a notable proportion of men with elevated PSA and prostatitis [2] [1]. However, persistent or rising PSA—especially beyond small transient blips or above common post‑surgery thresholds used clinically—may indicate residual or metastatic cancer, which is the alternative clinicians must always rule out, often using serial PSAs and targeted imaging such as PSMA PET [6] [8].
5. Limits of the evidence and practical takeaways
The literature supports that infection‑driven PSA elevation is real and often reversible with treatment [1] [2], and authoritative patient resources caution that any measurable PSA post‑prostatectomy should be followed up because the same lab signal can represent benign inflammation, assay cross‑reactivity, PSA from urethral or remnant tissue, or cancer recurrence [3] [6] [7]. What remains unsettled in the cited sources is precise thresholds or timelines that definitively separate benign post‑infectious rises from recurrence in every individual case; clinical judgment, repeat testing after treating infection, and imaging when indicated are how practitioners navigate that uncertainty [4] [2].