PSA detectable 18 mos after prostatectomy

Thanks Phil. I will bring this all up at my Oncologist meeting. I'm sorry, what does SE's in your reply stand for?

Almost the same, except the timing. Mine returned after ~3 years., but at low levels ( .05, .06) MsKCC does not recommend follow up until it hits.2, which it did in April, 2025, My oncolologist put me on Orgovyx right away and then started 25 pelvic radiation treatments in Late May. I'm done those and PSA is undetectable . < .05. Of course that could be due to the ADT so the PSA I get in ~ dec. will be a better barometer. However, a reputable study concluded that the 5 year rate of non-recurrence was almost 87%, so we should both be optimistic.

"If you had radiation first (which many men have), you’d be facing a lot of ADT for a much longer time, possible doublet therapy, and risky salvage surgery as a last resort."

Thanks for sharing that, Phil. Just to add to it, if cancer recurs after a prostatectomy or a large dose of radiation to the prostate, it's usually because some cancer cells had already escaped the prostate but had not yet formed tumours big enough to show up on scans. Unlike surgery, radiation can incapacitate cancer cells in the area immediately outside the prostate because the radiation continues to spread for a couple of weeks after treatment, but the downside is occasional mild radiation cystitis or proctitis caused by the same spread; regardless *both* will miss cells that have managed to move further away. If they form significant tumours somewhere else in your body, like the bones, lymph nodes, or more rarely lungs, then you may end up needing doublet therapy or triplet therapy (depending on how many metastases there are) and long-term ADT regardless of whether you started with radiation or surgery, unfortunately.

An unfortunate human-factors problem with both is surgeons or radiation oncologists who say "We got it all!" and give false reassurance to patients, when, frankly (as Phil suggests), there's no way to know with current medical science. A more honest statement after either radiation or surgery would be "It's likely your cancer was localised and low risk, so you may not see any recurrence for many years, if at all, but we'll keep a close eye on it just to be safe."

Side Effects?

SE = Side Effects

My situation is similar to yours. I had RP in April of 2018, then little over a year later had 35 radiation treatments. Now my psa has doubled in 5 months. currently at .67. I want to hold off on hormone treatment as long as possible. Currently I have no symptoms, and my first pet scan came back negative. My oncologist wants to get a bone density scan and does not want to rush the hormone treatments either.

I'm now 5 or 6 years from my Proton radiation treatments and I have had at least 5 PET scans. My PSA has been rising since to ,now a 12.8. I have talked this over many times with my radiation oncologist and the medical oncologist and we have all had the opinion of ,wait and see. I have not wanted to treat numbers and the wait finally paid off. My last PET scan was 2 weeks ago. My scan revealed a lymph node in the side wall of my left pelvic region. I'm currently waiting for a appointment for a MRI to further understand what is going on with the n9de and which direction we are going with treatments. It will be either with Proton radiation or ADT plus Proton radiation.
I am otherwise healthy, normal appetite, no pain, no urological issues and no bowel issues.
It has always been, a quality of life thing for me. I don't worry about this and I accept my outcomes. I have the full support of my wife, my family and my medical team. We have all been on the same page since day one. I am currently 81 and looking forward to many more years. Fighting any health issues is all about personal attitude and good medical physicians.
Good luck with your treatments of choice.
Harvey

That’s pretty amazing - and very unconventional - that the PSA would be allowed to get that high in the first place.
Don’t you worry that the ONE visible node (which is easily zapped) is just the tip of the iceberg? Couldn’t there be many, many more that have not shown up yet?
Not trying to raise alarm, but that’s just the way I think about this disease - always in the defensive!!
Phil

I'm fully aware that more may show up but one step at the time! It's at least something to treat. I haven't demolished my body for 5 years waiting for something to raise It's ugly head.

"I'm fully aware that more may show up but one step at the time!"

Exactly. No one knows what the future holds; those of us with cancer are just more conscious of the fact. We've already had a sneak peek, so if the Grim Reaper does eventually come for us before our time, we have an idea what he might be wearing — that's all.