Elevated PSA post surgery

[Alexa1234]

Hello, I am new to this forum. My father , aged 67 years underwent robotic radical prostatectomy on 27/7/2018. His PSA on 15/9/18 is 7.20. it was 31 pre operatively. He was diagnosed as T3N1M0. Gleason 4+4. Wondering what's next? Can anyone please suggest the next course of action...

[Tall_Allen]

You should talk to a radiation oncologist about salvage whole pelvic radiation with some hormone therapy.

[Alexa1234 in reply to Tall_Allen]

Thanx. I read somewhere that psa become undetectable in almost 3 months after the surgery. Since, it was 31 preoperatively, and has dropped to 7.2 in 6 weeks time. Should I wait for another 6 week and hope for psa to become undetectable or directly go for different treatment options ? Please guide... As he is already dealing with incontinence post surgery. I don't want to make it worse with radiation .... His psma pet and bone scan showed no evidence of metastasis...

[Tall_Allen in reply to Alexa1234]

No - his persistent PSA is unlikely to decrease (the half-life of PSA is 2-3 days). He can get another PSA within a couple of weeks to make sure it wasn't a lab error. It will probably take that long to see an RO anyway. But don't wait much longer to start ADT in preparation for adjuvant radiation.

[Shooter1]

Tall_Allen sound right. If a target get radiation. If not Chemo and ADT. My PSA actually went up after RP. Now in remission and looking at years ahead.

[Hidden]

You may want to have one of the newer pet scans, 68 gallium psma for example, before having radiation to make sure cancer is all in the pelvic region. If outside pelvic region radiation would be fruitless.

[Alexa1234 in reply to Hidden]

Thanx for your reply. I had 68 gallium psma 2 days before surgery. It showed no evidence of metastasis... All nodes negative. But 2/22 lymph nodes were found positive on histopathology of surgical specimen...