High PSA after surgery

RP was march 23rd. Testosterone level mid May was 38. (not chemically induced). PSA on June 2nd was .31. My PSA prior to surgery was 6.0 and gleason 3+4. I think my surgeon may have misled me. I had told him prior to agreeing to the surgery that I did not want to give up my sex life and did not want to be incontinent. He said I could go right back to my sex life after surgery and that I might need medication help for erections and that my physical health indicated I would get my continence back relatively quickly. The PSMA scan showed there was no spread of the cancer and therefore, removal of the prostate should have gotten rid of the cancer. Well, obviously I can't have a sex life with a Testosterone level of 38 and can't go back on the Androgel with a PSA of .31 and i'm still incontinent (which I will admit is not as bad as it was). I am in a very deep depression and extremely irritable (and have most of the other symptoms of Low T). I'm still very sorry I agreed to the surgery, but well, here I am.

I'm really wondering from those who have had higher PSA scores right after RP, how long before the doctor does radiation to get rid of the residual cancer? Will it get rid of the residual cancer? And will the surgeon have to wait until continence fully returns before starting radiation?

For the last 6 months, since receiving notification i had cancer, i've spent each and every day obsessing about this and don't see a way out until I'm done with whatever treatment I have to go through.

[Tall_Allen]

You will need whole pelvic radiation and ADT. How much ADT bears discussion:

prostatecancer.news/2023/02...

[Justfor_]

My best estimate for a successful sRT in your case is max 60%, min 30%, median 45%. Have this in mind because docs like to quote only the most favourable of scores. Also, ask your RO regarding second cancer incidence due to the received radiation 10 years down the road. If he/she nulls it down to zero, switch to an honest one.

[London441]

You say your testosterone is 38 and ‘not chemically induced’. To what do you attribute that? Do you know what it was at any point previously?

[Hidden in reply to London441]

oh. it's hypgonadism. i've been on androgel for over 20 years. my body doesn't produce testosterone on its own. prior to coming off the androgel, the highest was just under 300.

[London441]

I see. Well the urologic surgeon was being (typically for them) truthful when he said you could go 'right back' to your sex life after surgery. What he left out was that it would be a completely different one. So it goes, but there are things you can do to help. Seek some guidance.

Still, 2 hard truths: 1, that castrate levels of testosterone and sex as we knew it don't exist together. The other is that higher levels of T can feed the cancer, so allowing that is at our own risk.

The good news is how well we adapt. Our relationship with sex has to change, and it's by no means all bad. We have to adapt. Simple but not easy I know. The sooner you do the better your life will be.

[dentaltwin]

It took me several months to regain full continence, so the fact you haven't yet (but are improving) doesn't mean you won't.

Sexual function isn't what it was, but after pretty much ignoring it for a few years find it is still improving somewhat, even almost 5 years after RP.