How long after radical prostatectomy did you see a rise in your PSA?

@dlcd
Definitely read my message about estradiol and how it has many fewer side effects than normal ADT. There’s quite a long discussion there about it from Richard Wassersug PhD.

Mine never went below .03 after RP then to .04. At two years I was .22 with a clear PSMA which isn't unusual and then a year of battle due to radiation and its side effects. A week after Sigmoidoscopy and cauterization I am doing much better.

@chipe
After surgery, there’s always a biopsy done of the prostate tissue. Did you find out what the results were of that biopsy? Margins being mostly clean are a warning that BCR is very possible in your future. People want to hear their margins are all clear.

This points to the fact that you want to hear what the results were of your prostate biopsy. I can imagine the doctor saying you don’t need to do a decipher if your Gleason score is nine or 10, Indicating that there is a very high chance of reoccurrence. If your Gleason score is eight or less than maybe a decipher makes sense.

You really should consider getting a second opinion. Something does not seem right.

@chipe, how did the appointment with your oncologist go? What's next for you?

PSA was undetectable (< 0.1) for ten years after RARP in 2015.

This past June, PSA rose to 0.11 (Quest). Three months after that it was still 0.11 (Quest again), but I also did a Labcorp ultra sensitive test simultaneiously that came back 0.094.

I also had a small, palpable lesion in my prostate bed that glowed intensely on a PSMA PET scan (max SUV of 13.3). Pelvic MRI further confirmed a local recurrence. No evidence of distant mets.

In fall of 2025, I did 38 sessions in of salvage IMRT to the prostate bed and pelvic lymphs (prophylactic).

First post-RT PSA (3 months after last session, Feb 13) came back 0.084. If I stay below 0.1, both my RO and I will be happy.

@melvinw My husband has Gleason 8 and stage 3Tb. He had prostatectomy in May 2021. Almost 5 years later, his PSA rose above 0.2 last month.

What was your original Gleason Score, Decipher Test score, and prostate tumor classification and pathology report details?
The fact that your PSA started to rise so soon, suggests you had EPE, Surgical Margins, Seminal Vesicle invasion (one or both), and perhaps Cribriform gland tissue. In other words, you were something like a pT3b tumor classification or worse.
I am a pT3b which means I have a 25-50% probability of my PSA raising and the cancer returning “within” the first five years post-op. I had the DaVinci Robotic-Assisted RP.
Were all different, but I have a feeling that you might have had more severe, ominous pathology like I did, despite barely being a Gleason 3+4=7 with only 6-10% of cells being “4” graded cells.
Tell us more about your pathology report and tumor classification, because Biochemical Recurrence (“BCR”) of elevated PSA at 14 months is comparatively very early, unless perhaps, you had significant surgical margins tissue left in you, or it had spread to your lymph nodes. BTW…did you have a PET scan prior to surgery in your diagnostic phase? That would tell you and your urologist if the tumor/disease was confined to your prostate, or if it was already spreading, perhaps to your lymph node(s).
Good luck…I’ll look for your follow-up post.

21 months....

Pathology report said T2CNoMx
Negative:
Margins
ECE
SV

GS 4+4
10% prostate involved.

MSKCC monograms said I had a 30% chance of BCR in three years!

Your surgeon is not "wrong" but I think owes more discussion on what data is still needed and how to collect it before making a decision.

Things like at what PSA will you image? I say that because at very low PSA levels, < .5, you have a 1/3 chance of lasting activity. If imaging doesn't show anything, what then?

PSADT and PSAV can be important piece of data, factoring in the imaging decision, faster doubling and velocity may mean imaging at lower PSA has greater"success" as it may mean higher avidity. Same for treating or not, a PSADT >12 months may factor into a decision to do nothing and continue monitoring.
https://ancan.us14.list-manage.com/track/click
You have some of the clinical data to make a decision to treat, though not yet with what?

What else may be useful? Genomic testing, tests such as Decipher, PSADT and PSAV...

As to treatment, you have a range of options for treatment, ranging from

doing nothing but continuing to monitor and decide "later,"

Doublet therapy, ADT + ARI. You'll have to decide which agents and for how long, 6-36 months.

If radiation, you'll have to decide on which type, whether just to the prostate bed or include the whole pelvic lymph nodes (hint, include them...!)

Chemotherapy, yes, no? Best for high, not low volume...

I can't emphasize enough to separate the decisions...

What clinical data do we need to make a decision to treat and how do we get it?

Now that we have the clinical data that indicates treatment is necessary, with what and for how long do we treat?

Familiarize yourself with the NCCN and AUA guidelines when discussing treatment choices. Then discuss relevant clinical trials.

Most treatment decisions are "hybrid" decision based on the guidelines combined with applicable clinical trial results.

Kevin

@rlpostrp I was T3b with Gleason 9, the robotic RP. The doc said it was a very aggressive form of PC. I wanted to start salvage and ADT right away, but he talked me out of it. I have my PSMAPET this Friday and will know more then.

@prettypass2000 Very similar numbers to mine. The only difference is that I was Gleason 9. I am having my PSMAPET this Friday and will update everyone on the results as soon as I have them.