Detectable PSA now at 0.22 after RP in Nov 2018

Took 3 1/2 years before my PSA started rising after an RP. Had three more occurrences after that. The chance of this not getting worse is just about zero. I had salvage radiation and 2 1/2 years later it came back again. That’s not always true.

You really should get a PSMA PET scan or have salvage radiation. The PSA is still a little bit low to see anything with a PET scan. You really should talk to a radiation oncologist about your reoccurrence. Your urologist can set up an appointment If you can’t find one.

Here is what the American society of clinical oncology says about rising PSA after an RP.

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 concur with Jeff. With PSA >0.2, I would be concerned that this is a BCR. I think most urologists and oncologists would consider you a candidate for treatment.

Assuming a relapse, the long time to BCR is in your favor in terms of cancer aggressiveness. The other big factor in risk assessment is the doubling time of your PSA once it became detectable. PSADT < 3 months puts you in a higher risk group . PSADT >12 months puts you in a much much lower risk

Also, what was the Gleason score in your post-RT pathology report? That is an important factor. Did you have any positive margins?

I was diagnosed with a local relapse (lesion in my prostate bed), last June. Had a RARP in 2015. Pathology showed Gleason 3+4 and one positive margin. I went ten years with undetectable PSA (< 0.1). A DRE detected a small nodule in 2024, but it was a year later when my PSA hit 0.11 that I was diagnosed. A PSMA PET scan showed that the nodule was strongly favored to be cancerous (very intense uptake). Nothing was detected beyond the nodule. I underwent 38 sessions of IMRT to the pelvic area last fall without ADT. In February 2026, my PSA (ultra sensitive test) had dropped to 0.086. Both my urologist and oncologist were pleased with this first result after RT.

Generally, as Jeff has indicated, the earlier you treat a relapse, the better the odds are for knocking it out.

Best wishes going forward.

Although I did not have a Decipher Score, my PSA went from 0.01 in Sept 2019 (after surger) to 0.18 in June 2024.
The last year saw a steady rise at 3 month intervals. I opted for SRT with ADT based on the standard guidelines of treatment at 0.2.
So you should probably look at your last 3 PSA’s and plot the velocity; or simply look at the trend line and if it’s moving UP and to the right at a good clip you’re in BCR.
Phil

It will start going faster - what the other guys said, PSMA PET Scan

This is after prostate removal and after BCR and 39 EBRT.