PSA levels started to rise again but negative PSMA PET

@sammiam I had liver enzymes rise quite a bit while on Orgovyx (6mos) and was very concerned.
However, my RO told me the numbers would have to be FIVE times higher before ‘liver damage’ was even a concern.
We’re all different so your liver may react to a greater or lesser extent…Best,
Phil

@heavyphil
Just for the other point of view about liver issues. Eight years of ADT 2 1/2 years of Orgovyx My liver function, which is tested every month for the last eight years is just normal.

Everybody’s different.

@kujhawk1978 Ga68 agent detected mine at 0.42
Was small activity in prostate bed.

@cwd21682nd Yes that's exactly what I'm waiting on .After the Pet/ct showing some minor activity in the prostate bed at 0.52 agent was Ga68 in EU don't know what's used in US. My Rad/Oncologist. wants me to repeat MRI to maybe pin point where iz this activity. Planing to zepp it with cyber.

@debrazd

That's great and given the statistics, a possible outcome of the scan to inform a treatment decision.

For some, insurance issues may come into play, if a scan is done at levels such as yours and are negative, the insurance company may not approve the next one for a period of time.

Then there is the question of when to pull the trigger on treatment. For some, they and their medical team are comfortable with letting PSA rise to higher levels thus delaying treatment and its side effects.

There is no single right choice for imaging or treatment but there are a plethora of good choices.

@kujhawk1978 Yes that is a problem..souch problems shouldn't interfere with our decisions how or when to continue with procedures.
I'm in EU and coordinating with my Oncologist and Radiology with no issues with insurance, I can act on there's recommendation and yet my word is the last on accepting the procedures. Gov.helth insurance covers everything.

You might not have PSMA on your cancer cells. 20% of people do not produce PSMA on their cancer cells.

Jumping in here to see what your experiences are: husband had aggressive PCa, Gleason 4+4, PSA 19 in March 2026, 33 in April 2025, and 24 a week before RP in Aug. All tests & surgery done at Mayo FL. Other than long time to get appts, happy and we were praying for undetectable after clear margin no LN involvement report.
13 week post op PSA WAS 1.5, two weeks later 1.9, then three weeks later 2.0. Surgeon “very concerned”. Repeat PSMA PET shows nothing. Previously Prostate was “lit up” so it had avidity. Sent to med oncology. He was “very concerned . Repeat prostate MR showed nothing. Sent to Radiation oncology. He wants to do salvage radiation - 38 treatments for prostate bed and lymph nodes. And 6 months ADT. BUT … how effective will radiation be, and is it worth the side effects (already some UI and ED) if we don’t even know where it is? Has anyone else done radiation of prostate bed when it wasn’t showing and did it work? Rad. Onc. Said husband’s cancer obviously produces a lot of PSA so small amounts could be making the PSA go up from 1.5 to 2.0.
Thoughts? Experiences? Searching for answers.

@susanocl
I had salvage radiation 3 1/2 years after my prostatectomy when my PSA hit .2. I had no side effects from that radiation, Six years later, I did have incontinence problems, but that’s probably about surgery and radiation. I had 8+ weeks of radiation and the lower dose allows most to avoid the urinary issues.. if they do it in a shorter term and give more radiation that does cause some urinary irritation for many people, flowmax Usually resolve the problem.

After a prostatectomy, a PSA should become undetectable. The fact that your husband didn’t is a major issue. Something needs to be done soon.

After my surgery, I didn’t have any problems with incontinence, but getting an erection was impossible. That was 16 years ago so they didn’t spare the nerves back then.

I know dozens of people that had salvage radiation. I attend nine advanced prostate cancer meetings every month and hear from people that have had it done all the time.

Your husband really does need treatment and the salvage radiation will usually reduce the PSA to undetectable. It is not uncommon for the PSMA pet scan to find nothing, so they do the salvage radiation which treats the prostate bed and the lymph nodes in the area. That is the most likely place that there are mini metastasis that can’t be seen by scans. In my case, it gave me 2 1/2 years of undetectable PSA. That was 10 years ago. I’ve had three reoccurrences since but the drugs keep my PSA undetectable. My reoccurrences are due to a genetic problem I have BRCA2).

The American Society of clinical oncology (ASCO) sets standards for when salvage radiation should be done after surgery. Your husband is way beyond the maximum amount of time you should wait, That’s why your doctor feels it’s urgent. As high as your husband’s PSA is ADT is sort of essential to make sure that the radiation provides long-term results.

Here are the ASCO recommendations

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/