Welcome to our group. I’m not a doctor so my opinions are only based on my personal experience with prostate cancer. May I respectfully ask a few questions so that I and others on the forum can better respond to your post?

- If I understand correctly, you had one or more positive margins. Is that correct?
- You did not mention whether or not you had ADT or salvage RT after prostatectomy. Is that correct?
- Are you currently seeing a urologist, an oncologist, or both?
- Was any genetic testing done on the pathology? Decipher or similar?

It’s my understanding as a lay person that PSA levels that are undetectable (0.01 or less) are generally thought of as a curative level here in the US. It is my further understanding that if a a post-RP PSA level is above that and positive margins are involved, the typical standard of care involves at least a short course of ADT alone or in a combination with radiation to the prostate bed.

I’m hoping that your care provider includes a team of a urologist/surgeon, an oncologist, and a radiologist that all communicate with each other and work together. For my first go around with PCa in 2020, I opted for RT instead of RP and the radiologist was also my urologist and my oncologist. There was no team to speak of. When PCa came roaring back in 2023 I changed health systems and now have a care team working together for the best possible outcome. I hope you’re receiving excellent care.

At the time of your January 2023 PSMA PET scan, your PSA was so low (0.18 ng/mL) that the PET scan might’ve miss 2/3s of prostate cancers. (See attached chart.). As your PSA increases, a future PSMA PET scan will be more sensitive to detecting prostate cancers.

(My treatments consisted of 28 sessions of proton radiation (during April-May 2021), 6 months (two 3-month injections) of Eligard, and SpaceOAR Vue. PSA now varies between 0.35-0.55; not bad for still having a prostate.)

A few questions and inputs from a fellow patient.

When your PSA reached above 0.2 (Biochemical Recurrence point - BCR) in Dec ‘22, what treatments were proposed by your doctors?

Were all PSA tests performed by the same lab?

Assuming no change in labs, once a PSA level reaches 0.2, it is considered to be BCR and, as commented upon by others, there are “standard” treatments that most oncologists recommend. Also, as stated earlier, PSMA PET Scans will not detect most cancers at this PSA level.

I recommend assuming that you have residual PC cells, as indicated by your first post RP PSA and that those cells are growing and mutating.

I would also assume that you are still potentially curable, if the PC cells are localized to the prostate bed.

In my case, I choose salvage treatment when my post RP PSA was approaching 0.2. Theoretically, I could have chosen to wait until my PSA rose to 0.4 and a PSMA PET Scan was more likely to show where the cancer cells were located, but I didn’t want to risk that the additional PC cell growth would result in metastasis.

@samadhi, you've received a lot of helpful replies from members. Is your oncologist concerned about the rise in PSA levels? Are you currently taking any treatment or is treatment being discussed at this level?