Rising PSA.....after prostatectomy!

[Chuck67]

So I had a prostatectomy in 2021, I am now 57. Everything went back to normal....if you get my drift! I thought that this cancer diagnosis was behind me....it still is but I think something is looming ahead!! You see I have stuck religiously with 3 monthly PSA tests. When I first had my Prostatectomy my results after 3 months were 0.014 back in 2021. In the first year they stayed the same, the second year they went up a bit. In the last 12 months the 4 last results were 0.07, 0.08, 0.09 and a few days ago 0.14. My consultant has previously said that the standard is to do something at equivalent to or higher than 0.2. Judging on these figures I will be at that point in 3 or 6 months from now. Am I correct in this or am I just being hysterical!!?? 😆😱

[Justfor_]

Definitely, not "hysterical"! You got almost 4 years post RP which is good enough (I got 2.5 only). Time to start your research on the treatment to follow. 99 out of 100 will advise salvage RT. I did differently. FYI I am posting my PSA graph for the period alike, as I see some similarities.

PSA post RP

[Murk]

Yup, salvage radiation is the norm and you can read lots of peoples experiences here. IMO research a facility and Doc that is highly rated and has done thousands (not hundreds). Don't panic but don't wait. PCa is slow but the longer you give it the more chances of it Matastazing and becoming something serious..

[Gardenpests]

I'm absolutely no expert. To me, it looks like you had PSA persistence, perhaps due to some prostate tissue or cancer left behind. Now, it's growing. Personally, I'd be tempted to hit the prostate bed early with RT in hopes of killing it at the smallest possible size and before metastasis. This reference is from NCCN guidelines for clinicians.

nccn.org/professionals/phys...

"Trials indicating non-inferiority of early RT compared with adjuvant RT after RP have used a PSA threshold of 0.1 or 0.2 ng/mL to trigger treatment. Imaging and treatment at lower PSA levels may be appropriate in patients at high risk for progression based on pretreatment risk factors, pathologic parameters, timing of recurrence, and GC score, among other factors."

[NanoMRI]

Hysterical is subject to views and interpretations - which vary greatly with this disease. I rely on <0.010 as best indicator post RP; a good number of folks in this forum as well as docs would say I am hysterical. My post RP nadir was 0.050 and cancer indeed remained and had spread further than any doc 'thought'.

Ten years ago a urologist at New Victoria Hospital diagnosed my prostate cancer which had been missed by my American urologist for years. My first consultation was with Royal Marsden and there I learned they begin imaging for remaining cancer at 0.03 post RP ; note this is a private patient guideline and not what NHS nor American healthcare complex uses. All the best!

[London441]

Urologic surgeons commonly fill their patients with optimism of ‘cure’ throughout the RP process, but statistically RP alone often fails. This is why so many who choose surgery would have been better served with the radiation they subsequently need anyway.

Yes Salvage RT with or without ADT is the next logical step, for total eradication is still quite possible. No sense looking back, my RP post pathology was much worse than yours and I am doing well 4 years later.

[Hombre]

Hi ChuckI had a prostatectomy in 2004 when I was 60. There was some residual PSA a few months later and it was explained to me that this might be benign or cancerous. For a few years after that, the value became undetectable, but then started rising, doubling every six or seven years. It is now just over 0.20, stable. I have been offered salvage radiotherapy to the prostate bed, but have declined, as I also have two other conditions which potentially reduce life expectancy. I have no prostate symptoms and decided that I prefer to live life without the possible side effects of radiotherapy. However, I understand that radiotherapy is still effective at values less than 0.5, and if it increases towards that figure perhaps I'll change my mind. Just to add I had a PSMA scan two years ago which did not detect anything, although that is to be expected at low PSA values

Good luck!

[bagogeo]

chuck i had somewhat a similar.my psa after RP was 0.0125( 6-5-22)for a year it stayed there..Then at the 15 month mark the psa was 0.025.At the the 2yr mark i was at 0.04 .Three weeks later (8/5/24)i started RAD.I decided to due rad plus ADT..Before starting rad(8/5/24) i did orgovyx for 14 days.(1 rad/oncol said no need for ADT another said due it for 3 months)Day before rad my psa was 0.009..PSA at 11/11/24 at 0.006 .I def will do 6 months on orgovyx.I based my decision on my decipher report 0.63..pet psma was clear before rad.my psa was 1.6 when i started this whole thing,i saw the trend,my primary and urologist were not concerned,but i wanted the MRI.It was good excluding the 6 mm..Did the biopsy i was a 4+3....all parameters were good excluding positive margin which they were not sure if it spread . The capsule was not penetrated ,neg seminal ves..etc..I say do the rad to be safe..While i was on the rad and adt it didnt affect me that much,i still went to the gym 5 days/weekI .didnt need any more sleep than usual.Sure it affected my sexual life,but my other half was ok with it..The only thing that got me with the 25 rad sessions was some proctitus,but nothing i can't handle...I look back and wonder.I did psa's every 6 months as my father had it.when it jumped from 0.8 (give or take 20% reading error)for 15 years to 1.2 i got concerned,then 2 months later at 1.6..was time to get that mri..Maybe i should of been more pro-active and just gotten an mri at age 66 as my father had it at the same age as is doing very well at 94 yrs old.......I agree with the other post of 0.03 as a starting point.In the usa it varies from 0.1-0.2..I think that's risky..Staying below 0.1 per decipher with rad says superior results..Some things to consider....wish you well and other's going thru this...

[Shorter]

I am not the expert here, but my numbers started climbing quickly before the 2-year mark. I didn't wait and had salvage radiation, which shut it down for 3 more years. Why give it more time to spread?