PSA levels Post RP??

Posted by gchdrake @gchdrake, 21 hours ago

Hello,
I am 90 days out from my RP and just had my first PSA lab results returned and they registered at 0.4. Ugh.

Everything I am reading (will be consulting with my Surgeon soon) indicates the post RP numbers should be 0.2 to NIL.

I am about to head off to Europe for three months and am now hesitant....

My question is: Has anyone else had this experience, if so what was your path from testing higher than 0.2 until now?

Thanks much,
Gordon

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jsh327 | @jsh327 | 9 hours ago

Post RP, BCR (biochemical recurrence) occurs in approx 30% of patients when the post RP PSA reaches 0.2.

There are specific treatment guidelines for this condition which include salvage radiation to the prostate bed and, depending upon your pathology (Gleason, Decipher, etc) ADT.

Given the initial post RP of 0.4, I recommend contacting your urologist for another
PSA test immediately to confirm the value and, ideally seek treatment at a PCa center of excellence that can provide your detailed recommendations for both the different types of available radiation and, potentially, hormone therapy.

Others will respond with details as many of us have had this experience and had a successful salvage treatment

trusam1 | @trusam1 | 8 hours ago

If it were me (I had RP 2 years ago), I would anticipate an immediate plan for some sort of radiation therapy and probably androgen deprivation, such as Lupron. I would delay any travel.

heavyphil | @heavyphil | 8 hours ago

Double check the result; if still .4 or higher start Orgovyx. You’ll probably need radiation as well, but usually 10-12 weeks after starting ADT.
So 3 months in Europe is do-able; side effects may vary. Also, not sure, but I think you need at least 3 months to heal after surgery before starting radiation. The ADT is a game changer time-wise in your case.

michaelcharles | @michaelcharles | 7 hours ago

After RP in Aug, my initial 90 day PSA in Nov was .19 (confirmed 30 days later at .18)

Saw Radiation Oncologist in Dec and initiated Salvage Treatment of IMRT radiation to the whole pelvic floor and pelvic lymph nodes, together with short term ADT. See SPPORT trial.

Treatment Feb - June 2023.

All treatment at Johns Hopkins

Traveled to Europe for 2 wks Oct 2023.

PSA since Treatment undetectable < .02

ADT - I chose Orgovyx; would do so again.

Very sorry to hear of your persistent PSA.

Suggest you consult a RO. And either initiate treatment soon and reschedule Europe; or maybe ? begin ADT and continue treatment after your trip.

I would look to my Drs for direction, but I went directly to Salvage Treatment for persistent PSA.

Best wishes.

jeffMar | @jeffmarc | 5 hours ago

After RP, my PSA was less than .1 for 3 1/2 years then rose to .2 at which point they did Salvage radiation. Just like everyone else is staying here, this is Not unusual..

Yes, salvage radiation is probably what you need, But you need to speak to a doctor and find out what’s going on. A PSMA pet test would sure make sense. Did you have one before surgery? That could find where any metastasis is located and maybe they just need to do SBRT radiation. If they can’t find it, then salvage radiation is usually the answer.