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Rising PSA post Prostatectomy. Please, what should I expect or do?

Posted by coa44 @coa44, Dec 2 1:02pm

Please, what should I expect or do? What treatment options would you recommend? With Gratitude to you.

I had a prostatectomy three years ago. Since then, my PSA levels are as follows:
* April 28, 2023. PSA was 0.04
* August 1, 2023. 0.11
* October 30, 2023. 0.2
* February 2, 2024. 0.2
* April 26, 2024. 0.2
* August 26, 2024. 0.25
* December 4, 2024. 0.37
* March 24, 2025. 0.65
* July 28, 2025. 0.79
* October 13, 2025. 0.99

TWO PSMA PET SCANS
Between January 2025 and October 2025, I have had two (2) PSMA PET Scans. The results of both Scans are/were that:
* No tracer avid recurrent disease within the surgical bed of prior radical prostatectomy.
* No tracer avid metastatic disease.
* Chronic/incidental disease findings.

NEXT OFFICE VISIT FEBRUARY 2026
During my last office visit in November 2025, my Urologist discussed with me the "complexity in decision making" concerning my condition. The option(s) of Salvage RT, Enzalutamide, ADT + Enzalutamide or surveillance (for now) was discussed. After extensive discussion, I elected for continued surveillance.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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coa44 | @coa44 | Dec 5 11:14am
In reply to @beachflyer "Hello COA44 The use of active surveillance (AS) following BCR after prostectomy is an option that..." + (show)
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Hello COA44

The use of active surveillance (AS) following BCR after prostectomy is an option that may be offered based on PSA doubling time and other criteria including post surgical pathology. The argument for AS versus salvage radiation is based on a growing body of evidence that suggests 33 to 50% of men with BCR following prostectomy are over treated as their recurring cancer was indolent or of low grade such that it would not have impacted their life negatively. The issue as you might expect is how to determine which of us have an indolent BCR based on the testing available.
It appears that you have been on AS for a couple years now post prostectomy. Did your doctor discuss the AS criteria with you ? It looks like you had one year of fairly stable PSA around .2 however it is now rising so definitely time to ask questions about treatment options. What was your PSA and post surgical Gleason score and decipher score? That would likely have been a part of any AS plan.

I bring this up as my surgeon is a big proponent of AS following surgery and BCR for some men with favorable pathology. This very topic came up last month on my one year prostectomy anniversary Telemed conference call. I asked my Surgeon what happens if I get a rise in PSA? He said based on the rate of rise and other factors he might likely recommend AS.
BTW , When I chose Dr Ahlering as my surgeon I had to agree to be part of his longitudinal study cohort. He is following UCI PCa patients for the next 15 years tracking their progress and one area of focus is exactly this topic of AS following RARP with a BCR.
Until stepping down last year to focus on research, Dr Ahlering was the Vice Chair of Urology at UCI which is a center of excellence.

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@beachflyer

Thank you so much for your support. It is very helpful.

Over the past six months, I have made two office visits to my Urologist. Each time, he discussed all the treatment options including AS. The Urologist always referenced my Post Surgical Gleason Score, PSA, etc. On the most recent visit on November 6, my wife and I agreed with the Urologist to settle on what/which treatment options during my upcoming office appointment which will be in the first week of January 2026.

I will keep MCC posted on developments after my January 2026 office visit.
Indeed, I am blessed to belong to MCC.

Thank you to everyone for the warm support.

REPLY
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chippydoo | @chippydoo | Dec 5 12:19pm
In reply to @jeffmarc "@chippydoo If you have radiation as your initial treatment, then the recommendation is not to do..." + (show)
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@chippydoo
If you have radiation as your initial treatment, then the recommendation is not to do anything until the PSA rises 2 over the lowest it reached after radiation.

Some doctors like Dr. Scholz of PCRI fame, believe that you should just zap the metastasis as they come up. Waiting until the PSA hits 2 May be a little overdoing it but maybe not. Many people would want a PSMA PET scan when it reached 1.

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@jeffmarc I have to trust someone at some point as I have lost confidence in my SO and a very large practice that is more or less a monopoly in my area. I got my second at a NIH Comprehensive Cancer Center with the GU dept. head. Hopefully I won't have to deal with it for a long time or ever. As we both know this cancer can pop at anytime after treatment. I know 2 guys that popped a number around 12 years free and clear recently. If I move south which we are considering, I would be a couple of hours from Mayo Jacksonville where I would move my care to.

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coa44 | @coa44 | Dec 5 2:20pm
In reply to @jeffmarc "@chippydoo If you have radiation as your initial treatment, then the recommendation is not to do..." + (show)
Profile picture for jeff Marchi @jeffmarc

@chippydoo
If you have radiation as your initial treatment, then the recommendation is not to do anything until the PSA rises 2 over the lowest it reached after radiation.

Some doctors like Dr. Scholz of PCRI fame, believe that you should just zap the metastasis as they come up. Waiting until the PSA hits 2 May be a little overdoing it but maybe not. Many people would want a PSMA PET scan when it reached 1.

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@jeffmarc

Thank you.

REPLY
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icorps | @icorps | Dec 6 10:16am
In reply to @coa44 "To all my wonderful community, I listened and heard you well. This morning, I rescheduled my..." + (show)
Profile picture for coa44 @coa44

To all my wonderful community, I listened and heard you well. This morning, I rescheduled my February 2026 appointment to the earliest available date in the first week of January 2026. During this upcoming office appointment, I will discuss with my urologist and ask him to proceed with treatment instead of further active surveillance.

I want to further add that my doubling time is 11.5.

Again, thank you so much for the warm support. I look forward to an ongoing relationship with you.

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@coa44
Good luck!
Seems like a good choice.
You might want to AI Google your situation to get a better grasp of your urologist thinking..
Things have improved so much with the wider use of PSMA pet scans which can more readily detect smaller spots of the cancer. Often radiotherapy extends the field of zapping nearby lymph nodes to the spots where cancer is seen on the theory that they may have undetected micrometasis the PSMA scan can't detect.
Sounds like your doc is being extra safe here by also giving you ADT and Enzalutamide which not only helps the radiation work better (they still don't really know why it does that) but also systemically goes throughout your body to kill undetected micrometasis cells. I can attest to Enzalutamide's
efficacy. A three month dose without ADT dropped my PSA from 3.47 to undectable.

REPLY
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lacraig1 | @lacraig1 | Dec 7 12:31pm

When my PSA started rising rapidly, starting from .1 to .18, my urologist, who specializes in prostate cancer, told me to see a medical oncologist. Because my Gleason score was 7 and some other test showed aggressive cancer, he wanted to do ADT and radiation right away.

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