Puzzling about PSA rise 7 years after prostatectomy

I'm sorry. That must be frustrating and frightening to see the rise, even though your PSA is still at a very low level.

Nothing but further testing can tell you what might be going on. I suggest reaching out to your Cancer Centre from 7 years ago if you're still on their roster (or going through whatever channels you have to go through to get back to them). They won't be able to give you answers right away, but they can start the process moving to get some for you.

Best of luck!

Just keep getting your PSA tests done; maybe now every 3 months so you can see if your PSA velocity (doubling time) is increasing. Why bite your nails for 6 months when you can do it for 3?🫣. Just kidding - but it does help mentally when you are more proactive.
Best defense is a good offense…
Phil

If it were me, I would talk with your urologic surgeon about when you should take a PSMA Pet scan. In addition, although the biomarker PSE test is used quite a bit with a PSA test to evaluate if one has prostate cancer, according to the maker of the test, Oxford Biodynamics, it also can be used to discover re-occurrence.

Sorry to hear that your PSA is detectable. I am going through something quite similar, so I am all too familiar with the surprise, anxiety, and puzzlement over what to do next.

I had a RARP in 2025. Pathology showed Gleason 7 (3+4) with one positive margin. Prolaris score gave a 53% chanced of BCR at ten years.

For ten years my PSA was undetectable (< 0.1), and all was well.

In 2024, my urologist detected a small nodule in my prostate bed during a DRE, but my PSA was still undetectable, so no further action at that time.

A year later, in June 2025, my PSA rose to 0.11. A repeat test a few days later came back at 0.12, ruling against lab variation.

Because a nodule had been detected previously, I was referred to an advanced prostate cancer urologist who confirmed the nodule during another DRE and ordered a PSMA PET scan even though my PSA was below the threshold for a BCR. Even with the low PSA, insurance did approve the scan, probably because a nodule was detected.

On the PSMA PET scan, the nodule lit up like a Christmas tree, but there was no other activity beyond the nodule. I was diagnosed with a local recurrence and referred to a radiation oncologist. A pelvic MRI was performed, which further confirmed the local recurrence, and showed no evidence lymph node involvement. My urologist, oncologist, and I all agreed that a biopsy was unnecessary at this point.

Three months after diagnosis, my PSA was still 0.11 (Quest), and an ultra sensitive PSA test (Labcorp) yielded 0.094. So nothing had changed and my PSA was essentially, 0.1. If not for the palpable nodule that glowed like crazy on the PSMA PET scan, I probably would have been scheduled for another PSA test in 3 months, and put on surveillance for a BCR.

But, I was a candidate for salvage radiation, even with the low PSA. I was treated with IMRT over 8 weeks (38 sessions) and opted not to have short-term ADT. Finished RT on November 18, 2025. I will have my first, post-RT PSA test in a couple weeks.

Anyway, I agree—get back with your urologist and at minimum schedule follow up PSA testing. If it was me, I would have a DRE to check for any palpable nodules. If present, that could certainly change the situation, as it did for me. If there isn’t a palpable nodule, my guess is that the immediate course would be continued PSA monitoring versus immediate treatment. But you just gotta work with your care team on how to proceed. You’re in a bit of a gray zone with respect to what is, or is not, occurring.

You can’t totally rule out lab variation for the 0.12 result. If it was me, I would do an immediate follow-up test, even if I had to pay OOP.

Make sure to stick with the same lab for your PSA testing. Different labs/different instruments and methods give slightly different results. This is especially critical in cases like yours and mine where PSA is just barely over the limit of detection.

I doubt that you would have any physical symptoms (I certainly did not).

If you are experiencing a recurrence, the good news is that it has been more than 3 years since your prostatectomy and your PSADT is greater than a year. These are favorable factors for a less aggressive PCa.

Best wishes to you. Keep us posted on how things develop.

Mel

My PSA started rising 3 1/2 years after my prostatectomy. When it hit .2 my medical team gave me a Lupron injection and two months later salvage radiation. The fact that yours is rising slowly may be a benefit, but if it hits .2 you really have to be ready to do something. This information is from a group that sets the standards for treatment.

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/

I just posted about PSA's on another thread. I had a PSA test yesterday at Quest Diagnostics in Mpls. PSA was 5.1 compared to 6.2 in Dec at Mayo. Their report states Quest uses the Who system which is 20% lower than Beckman Coulter system . I asked AI (fwiw) what system Mayo uses and they said the Beckman. I haven't seen this mentioned before and am wondering if either system is more common. It's important to know where your baseline came from.

@dribbles My hospital's lab calibrates PSA to WHO Standard 96/670. I hadn't realised there were labs who didn't use that. 🤷

Live and learn.

You already got very good advice from other members - I would just like to add that some other glands produce PSA (like salivary) and also recent respiratory infections can elevate PSA.

Level of PSA 0.2 is usually considered BCR and only for very aggressive cancers lower PSA is sometimes used as a threshold.

The best thing would be (as others stated) to contact your doctors and start monitoring your PSA every 3 mos and see what is an actual trend.

Wishing you all the best and NO BCR - may this be just a false alarm for you < 3

@surftohealth88 I'll just add that thresholds are different after treatment. If your prostate is removed or radiated, and you're _still_ seeing a PSA ≥ 0.2, then it warrants further investigation, especially if you're also on ADT.

(It might not be anything serious, of course, but they need to monitor you closely.)

@northoftheborder
Yes - thanks for adding this fact in this thread. : )
There could be people here who are reading and do not know that threshold is different for RP and RT patients. I was concentrating on answering to this particular patient who had RARP , but it is wise to always consider having new members here.