Hi,
It's been a while since I was on this forum, but I am in need of some advice. I had a radical prostatectomy in 2021 followed by salvage radio therapy. My psa levels have been rising slowly since then and I wondered if there was any advice as to what it might mean and if there is anything I should be doing at this point?
23 March 2021 – 0.01
28 July 2022 – 0.04
18 August 2023 – 0.18
21 February 2024 – 0.3
27 March 2024 – 0.37
Any help much appreciated!
Sorry can't help much since I am further behind you in the process.
But as you await some great replies from the community here, I would search out a highly rated RO and MO at a leading facility. Even if you are comfortable with the Docs you have this search at a minimum will provide you the avenue of a second opinion. Even travel for this service or 2nd opinion.
This time around you want to nail it.
After my salvage RT failed to get it all, instead of ADT/chemo, six years ago I had salvage extended pelvic lymph node surgery. Six cancerous nodes were removed and my ePLND nadir was <0.010; that held for two years. My usPSA has held very low stable 0.03X range past two years. I am staying on top of this beast with bi-monthly usPSA testing, imaging and blood biopsy testing. All the best!
Thank you for replying, I need to get myself referred to my oncologist, I was signed off over two years ago.
With a PSADT of 6.8 months you are on the moderately aggressive side of the scale. Don't waste any more time, go for a PSMA PET/CT now. They will tell you to wait until your PSA breaches 0.5 or else "it will detect nothing". Pure and extremely well groomed nonsense. And pray that it will detect nothing. This will be really good news. My two Euro cents.
Thank you! Will follow your advice or do my best to, as I am in the UK and the NHS can take a while to respond…
Well, I know first hand. My daughter lives permanently in the UK and when she comes on vacation to Greece schedules all medical consultations, tests, imaging, etc, bar those necessitating emergency actions. If anyone told me 30-40 years back that there would come a day when preference between the NHS and the Greek public healthcare system would swung towards the latter, I would had responded in true frankness: "impossible".
I am a patient in both the US and UK. Frankly, in my experiences the UK is ahead of the US in prostate cancer diagnosis from initial findings through recurrence. I had a company and staff in UK and found the private health insurance I provided staff did provide a bit sooner response, and of course, my medical consultations in UK were as a private paying patient.
Thank you, sadly I don’t have insurance nor can I afford to go private. Will just have to wait my turn.
I understand. Even here in US with private insurance often we have to be strong self-advocates, pushy/demanding really, as guidelines, clinical practices, medical contacts etc. are not always in our favour.
Nothing worth doing yet - just keep monitoring PSA. If it goes up quickly or exceeds 0.5, you may want to get a PSMA PET scan, which may indicate further medical treatment.
Thank you, when you say ‘may want to get’ does that mean it might not be necessary?
Post RP and salvage RT, I am most grateful I acted with imaging and ePLND at 0.13 and that I did not wait until 0.5. Looking back, I wish I had acted before 0.1 - but then, I am just a patient with experience that wants to defer ADT and likely inevitable CR for as long as possible (likely inevitable if nut'n else gets me first). All the best to all of us!
PSA rise after RP
Rising PSA 
Treatment prognosis
After Orgovyx
