Post prostatectomy: What do rising PSA levels mean?

Hey buddy, great news for sure! What was the debridement all about - was that part of the procedure?
Phil

Phil,
The damage from the radiation cystitis was producing a fistula near the bladder neck. I had a prior surgery in October to try to repair and seal that area with no success. Thus the cystectomy, while I was waiting for my appointment once we determined the repair was unsuccessful, the area that they had tried to repair started leaking again Through another fistula. The bacteria in the urine settles in the lowest part of your abdomen, which then can infect your pelvic/pubic bones. Through an MRI with contrast, they found that this infection was starting to deteriorate the pelvic bone in that area. So when they went to remove my bladder, they had to take out the damaged area of the bone until they saw a good bleeding bone For recovery. They tied in some antibiotic seeds to this area and now I am on a six week regiment of heavy duty infusion but able to do it at home thank God. The abdomen pain from the surgery is going very well. It is just the hip pain infection that is causing me mobility issues that I was not expecting. Al

Wojo ,
Follow the Drs that you’re working with. I had RP removal and margins were clear……… for 6 years. The numbers started rising. 39 treatments of radiation treatments. That was in 2020. Sorry to say , buts lots of issues followed 2 years later. I would ask about ANY type of alternate therapy to radiation IF it comes to this later. Sorry this is so negative , but just want to stress to look at options versus automatically going with routine radiation. Best of luck to you.

What type of issues are you referring to?
What was your first PSA number following SBRT?

My numbers started out very low from undetectable too .10 3 months later .19 continual checks kept slow slowly gaining to .55 is when I think we decided to start looking and found that the cancer had returned to areas around the prostate pocket and which is also the base of the bladder. I went almost 2 years after being undetectable again and now March 2025 the numbers have started to gain slowly again. In between the end of the radiation and today, I had quite a year of issues mainly 2024. It started with bladder, neck, bleeding, and catheters to be able to keep from clotting. Incontinence issues throughout the year.
Attempted JP drains to drain the areas where the bladder was feeding the fistula to no avail. Another surgery in October to try to fix the bladder neck area that was having all the issues. They tried omental flap to see if it could heal the damage.Through this process, I was taking 68 hyperbaric oxygen therapy treatments to see if I could help new blood cell growth in that area that was damaged by all of the radiation. The HBO therapy did not seem to have the results we were hoping for. That is when we made the decision to have the cystectomy which was performed February 28. Very relieved of the painful situations I was having throughout 2024. I still have healing going on but nothing like the issues I was dealing with. To top it off infection from the leaking bladder created bacteria that got into my pelvic bones and was almost disabling. High doses of antibiotics prior to and a six week regimen after surgery into mid April.

You are living the fear we all have: radiation doing more harm than good? Radiation damage is extremely difficult to deal with; normal surgical techniques often fail since whatever the surgeon touches already has a compromised blood supply.
Even the hyperbaric O2 didn’t work….man, you just didn’t catch a break anywhere…

I had recurrence 18 months after surgery so not the same but...time to gather some clinical data to inform a decision between you and your medical team. You should have the Pathology report and your surgeon should have discussed with you his notes. In my case the pathology report was T2CNoMx, GS 4+4, ECE, Margins, and SV Negative, 10% involvement.

Next will be determining PSA doubling and velocity which generally needs three PSA results, there is some discussion about the spacing between those, three months. There are online calculators, Memorial Sloan Kettering has one.

Finally, with a PSA of .7, you may want to image using one of the recently approved FDA scans - https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-second-psma-targeted-pet-imaging-drug-men-prostate-cancer

Informed by that clinical data , your research and your medical team, you can make a decision whether to treat, if so, when and with what. It may be, monotherapy such as radiation or a combined regimen involving radiation and short term ADT, say six months.

I was definitely "disappointed" when my prostate cancer returned after surgery, after I got over the feelings, anger, frustration..I gathered the data and made my next decision. I chose not to "look back" about my decision to do surgery and focus on the next decision I needed to make.

I was diagnosed in Jan 14 at age 57, like your husband, the result of a colonoscopy (PSA was 2.1, my mistake was not having a DRE one during annual physicals but since the PSA was 2.1, who knew...!), surgery in Mar 14, BCR in Sep 15, SRT in Mar 16, then 18 months of ADT, six cycle of taxotere and 25 IMRT to the pelvic lymph nodes. I finished that regimen in August 2018 and it's now three years, other than seeing my urologist every two-four months for labs and consult, no further treatment.

Your husband may have advanced prostate cancer, If so, SRT may "cure" it but there is discussion that the best chance to do so may be at lower PSA than what your husband currently has. This may now be a case of managing a "chronic disease." In the seven years since my diagnosis much has changed, to the better, imaging, treatment modalities,

Kevin

What is SRT?

Hello @itterac, Welcome to Connect. From what I've read everything under 4.0 ng/mL is normal. Here's some information I found about your question.

Does Working Out Affect Testosterone Levels?: https://www.webmd.com/men/features/exercise-and-testosterone#1

It sounds like you may be concerned about the rise in your PSA since your radical prostatectomy (RP). Have you asked your doctor about your concern?

How can you say everything under 4.0 ng/ml is normal for someone who is post RP?... Everything i have read sugests that anything ABOVE 0.01 (undetectable) is something to pay attention to...