Input on PSA rise 3 yrs Post RP

I have not had the same results post LARP. Mine have all been < .01. However if I did have a trend upward as yours have been with your post op pathology, I dont think I would mess with any more watching.

Mine started to rise 3 1/2 years after RP. At that point I had salvage radiation on the prostate bed.

They usually like to do something when your PSA rises to .2 after an RP. You should discuss this with your doctor.

I believe that you have sufficient data to prompt a discussion with your medical team. While it is not necessarily unusual for a PSA to vary from 0.46 to 0.42 during a 53 day time period, depending upon what else changed in your body during that period of time, a rise of PSA from 0.1 to >0.4 during a year would prompt a majority of PC specialist medical teams to potentially initiate a PSMA PET scan and likely recommend treatment options for recurrence. In general, recurrence treatment planning begins when the PSA rises from < 0.01 to >0.20, with some treatments initiated earlier, depending upon the post RP pathology and PSA doubling rate. Hopefully, if a recurrence is has occurred, it is local and can be treated with local therapies such as salvage radiation. If that treatment becomes recommended for you, I recommend that you solicit I out from this group, as many have helpful experience.

3 elevated PSA tests suggest biochemical recurrence (BCR). And your risk factors post surgery are noteworthy.
My suggestion would be to consult a Radiation Oncologist and/or a Medical Oncologist.
I had Gleason 9 w/ Extraprostatic Extension (EPE) postop pathology following very successful surgery at Johns Hopkins. However, persistent PSA .19 & .18 90 and 120 days postop.
Referred to Radiation Oncologist for salvage treatment of radiation to the whole pelvic floor region (WPRT) and pelvic lymph nodes together with 4 mos ADT. See SPPORT trial.
There is a Jan 2023 video on patient resources tab from the Prostate Cancer Foundation pcf.org on rising PSA following initial treatment.
My understanding is. 2 - .4/.5 is the "sweet spot " for salvage treatment. Also, 2 friends treated similarly postop.
My PSA has been undetectable < .02 for about 1 yr since completion of Salvage Treatment. Very happy and hopeful.
Best wishes.

That's an excellent question and you may get a variety of answers from this forum.

I see for the first two years the frequency was every three months, annually after that based on the first two years as undetectable. After that, you're medical team went to an annual basis.

That is consistent with AUA guidelines - https://uroweb.org/guidelines/prostate-cancer/chapter/followup
Part of that is your risk, Grade Group, the fact that your pathology report said high risk with positive margins, Perineural invasion and invasion into the neck of the bladder.

You could put your results into MSKCC PSADT nomogram to gain an idea of PSADT and PSAV.

There can be variations, unexplained in PSA testings. When my urologist switched to USPSA, first one came back at .326, I almost hit the panic, button, we tested again in two weeks and six weeks after that, both went down. Why, who knows.

I think the answer lies in you, are you and your medical team comfortable with say three months or given your risk factors, one or two...?

Another questions is does waiting three months carry a risk of change the outcome of your PCa and a treatment decision (doublet, triplet, will radiation be a part of it) - would it allow the PCa to spread such that a treatment decision may change versus one to two months. Given your risk factors, you may consider more frequent testing. Have you discussed with your medical team, what do they say.

More importantly is do you have decision criteria around what to do with the results...? Mine were, and are, three or more PSA increases spaced three months apart, PSA between .5-1.0. When the clinical data hits those decision points, we image and informed by the results, decide on treatment, what, for how long, criteria to come off treatment...

Ultimately the decision is yours. If your decision is different than what your medical team wants to do, remember, it's your decision and they are on your team to support you, write the damn order...!

If you ask what I think, well, three months at this point does not carry a risk of progressions such as your treatment options will change drastically if at all. You would not be wrong to ask for monthly or every two months. I think they answer may lie in what decision criteria you have for determining when to go on treatment and an important part of that is imaging which at .5 or higher (can be less though) can more and more locate recurrences.

One conundrum is treat too late or treat too soon. Another is treat too aggressively or not. Given your clinical history, the 2nd conundrum may be an easy choice when you decide to treat, aggressively!

Kevin

Thank you for the information. Do you mind sharing what yours rose to when you started salvage radiation? Again, thank you.

I looked at the site pcf.org you mentioned. Thank you as it was very helpful.

Sharing your information was very helpful. Thank you!

I want to thank all of you immensely for your invaluable input. I have a PSMA-PET scheduled for Sept. 13. The question then is if nothing shows at that time, do we proceed with salvage radiation. Seems the majority opinion from doctors is to proceed with salvage radiation given PSA level has increased to >0.4 . Again, thank you!

My PSA rose to.2 on 2-7-2014 Radiation started 4-2014 and ended 6-16-2014 next PSA 9-30-2014 Was less than .1.

Started Lupron 3-2017 when it started rising again. Stayed on Lupron until 3-2024 when I switched to Orgovix.

I have BRCA2 so my psa rises if I don’t stay on 2 drugs.