Slight rise in PSA 24 years after radical prostatectomy!

@topf Good point. Check to be sure the result wasn’t reported as < 0.2. An ultra sensitive test should really be reported to two places after the decimal.

I have been corrected several times about calling this cancer cured. I was a 3+3 and wanted to get it while it was contained. LARP - Post-Op confirmed containment. That was 6 years ago. Still undetectable. I am 74 now. So if I get another 20years . Thumbs up. You can move the can down the road with this cancer but it sure works on your mind and manhood the rest of your life. Lets hope its nothing.

Last June, I was diagnosed with a local recurrence (age 72), ten years after a RARP in 2015. Post-surgery pathology showed a Gleason score of 3+4, with one positive margin. My PSA was undetectable (< 0.1) through that ten years, then during my annual urologist visit in 2025, it had risen to 0.11. The kicker though, was that a year earlier a small nodule was detected in my prostate bed. The PSA level of 0.11. combined with the palpable nodule put further evaluation into motion. First was a PSMA PET scan. The nodule lit up like a Christmas tree on the scan, strongly suggesting it was cancerous. That was followed by seeing an oncologist, and then doing a pelvic MRI, which further confirmed that the nodule was cancerous. Fortunately, neither scan detected evidence of distant mets. After seeking opinions from two other oncologists, I underwent 38 sessions of radiation therapy last fall (IMRT). In the three months from initial PSA rise to the start of therapy, my PSA had not changed. Radiation side effects were minimal (mostly fatigue) and my PSA dropped below 0.1 (0.086 on an ultra sensitive PSA test) three months after finishing radiation. Anyway, so far so good.

Radiation therapy has advanced tremendously since your surgery 23 years ago, and even has made big advances in the last few years. The treatments are much more precise and side effects have been reduced.

It does sound like a PSMA PET scan is the next step. These scans don’t always detect lesions at PSA levels below 0.5, but it sure did in my case. But, at 0.2 PSA, you meet the criteria for a possible BCR, so I expect a scan will be recommended.

In terms of cancer aggressiveness (if you do have a relapse), the long time to relapse (23 years) and the unchanged PSA over three months and low Gleason score (6) are strongly in your favor. Dr. Patrick Walsh’s book, “Guide to Surviving Prostate Cancer” has a chapter in which he gives tables with statistical estimates for survivability and development of distant metastases. The tables use Gleason scores, time to first recurrence after surgery, and PSA doubling time. They are definitely worth having a look at.

I was surprised when I was diagnosed with a recurrence at ten years, although with a positive margin and a Prolaris score that gave a 53% chance of BCR at ten years post RARP, I was not completely shocked. We both are statistical outliers, but relapses do occur even after ten and twenty years.

If I was in your position, I would collect all the data I could, and get multiple opinions from oncologists. I would get a PSMA PET scan as soon as possible, then proceed from there. Test PSA again in three months, or just before initiating salvage radiation.

Hoping that your recent PSA readings are just flukes, but even if not, you have much better options than 23 years ago and some breathing room to make some decisions about treatment.

@xahnegrey40 Actually, I should share a bit more. In Nov. 2023, my PSA came back at 0.2 .. at the time of my annual physical. I was in the midst of recovering from two back surgeries and PT, and the PCP didn't say anything and I didn't notice. In Nov. 2024, it was at 0.19. And again I missed it. Then, in Nov. 2025, it was at 0.2 and I noticed it. According to the American Urological Society, two subsequent readings of 0.2 indicates that further inquiry should be made. So the PCP made recommendations to the two local urologists, neither of whom would take me as a patient. In February, I asked them to recheck the PSA to see what the reading was. That one also came back at 0.2. So I now have two "subsequent" readings of 0.2. I called the office of the doctor who did my surgery, and it turns out that they have satellite offices all around Atlanta. The closest to me is 45 miles away, and when I called there I had no problem getting an appointment. It's not the doctor who did my surgery 23 years ago, but the offices are connected. So, my PSA has actually been "hovering" around the 0.2 since 2023. And since it has not rapidly increased over 3 years, I feel a "bit" more reassured. But I know it still needs to be checked, and I'll just have to wait and see what this doctor recommends. I'm going to ask about the PET scan if he doesn't recommend it because I'm the type of patient who wants to "know for sure" if anything is there. Judging by the comments of others here, the side effects of radiation may not be as bad as I had read/heard. I'm sure so much has changed in 20+ years. Best wishes! Mike

@xahnegrey40 Actually, I should share a bit more. In Nov. 2023, my PSA came back at 0.2 .. at the time of my annual physical. I was in the midst of recovering from two back surgeries and PT, and the PCP didn't say anything and I didn't notice. In Nov. 2024, it was at 0.19. And again I missed it. Then, in Nov. 2025, it was at 0.2 and I noticed it. According to the American Urological Society, two subsequent readings of 0.2 indicates that further inquiry should be made. So the PCP made recommendations to the two local urologists, neither of whom would take me as a patient. In February, I asked them to recheck the PSA to see what the reading was. That one also came back at 0.2. So I now have two "subsequent" readings of 0.2. I called the office of the doctor who did my surgery, and it turns out that they have satellite offices all around Atlanta. The closest to me is 45 miles away, and when I called there I had no problem getting an appointment. It's not the doctor who did my surgery 23 years ago, but the offices are connected. So, my PSA has actually been "hovering" around the 0.2 since 2023. And since it has not rapidly increased over 3 years, I feel a "bit" more reassured. But I know it still needs to be checked, and I'll just have to wait and see what this doctor recommends. I'm going to ask about the PET scan if he doesn't recommend it because I'm the type of patient who wants to "know for sure" if anything is there. Judging by the comments of others here, the side effects of radiation may not be as bad as I had read/heard. I'm sure so much has changed in 20+ years. Best wishes! Mike

@melvinw Thank you for sharing your experience with the salvage radiation. I'm sure things have changed a lot in 20+ years. While I believe in 2nd and 3rd opinions, I'm just wondering if the opinions from other oncologists you saw were very different from each other. Best wishes to you! Mike

@xahnegrey40 Actually, I should share a bit more. In Nov. 2023, my PSA came back at 0.2 .. at the time of my annual physical. I was in the midst of recovering from two back surgeries and PT, and the PCP didn't say anything and I didn't notice. In Nov. 2024, it was at 0.19. And again I missed it. Then, in Nov. 2025, it was at 0.2 and I noticed it. According to the American Urological Society, two subsequent readings of 0.2 indicates that further inquiry should be made. So the PCP made recommendations to the two local urologists, neither of whom would take me as a patient. In February, I asked them to recheck the PSA to see what the reading was. That one also came back at 0.2. So I now have two "subsequent" readings of 0.2. I called the office of the doctor who did my surgery, and it turns out that they have satellite offices all around Atlanta. The closest to me is 45 miles away, and when I called there I had no problem getting an appointment. It's not the doctor who did my surgery 23 years ago, but the offices are connected. So, my PSA has actually been "hovering" around the 0.2 since 2023. And since it has not rapidly increased over 3 years, I feel a "bit" more reassured. But I know it still needs to be checked, and I'll just have to wait and see what this doctor recommends. I'm going to ask about the PET scan if he doesn't recommend it because I'm the type of patient who wants to "know for sure" if anything is there. Judging by the comments of others here, the side effects of radiation may not be as bad as I had read/heard. I'm sure so much has changed in 20+ years. Best wishes! Mike

@domiha The first RO I met with wanted to add short term ADT (Orgovyx) to RT. Next I talked to an MO who wanted to hit me with all kind of hormone therapy drugs along with RT. Then I met with another RO. She was more agnostic about the ADT and was totally comfortable with just treating with radiation.

Because I was intermediate risk, along with low PSA and a long time to recurrence, adding ADT to RT was big gray area. Because of the potential metabolic risks of ADT, some docs won’t recommend it for intermediate risk relapse patients with PSA less than 0.5.

The first RO hit me with a FOMO argument for doing ADT which I didn’t appreciate. He also cited a published trial in support of his ADT recommendation. I thoroughly perused the paper he cited and challenged him on how he was extrapolating the results of the study to apply them to me. I got him to admit the he was overreaching the data. The MO just reflexively recommended a battery of hormone therapy drugs without any discussion of risks and benefits. When I pushed back, he said “okay” and passed me on to the RO I finally worked with. She also was more tuned into my goals and priorities, and comfortable with my assessment of the medical literature.

As everyone is saying, it is a very good sign that your PSA is stable, even if it is 0.2. Also, like everyone is saying, a PSMA PET scan might not be sensitive enough to detect anything at this point. But there is one simple blood test you can take called the EpiSwitch PSE test that is 94% accurate on indicating the presence of prostate cancer in your body. See details here https://www.94percent.com/ Of course, close monitoring of your PSA is required no matter what and any further rise in PSA would trigger the need for a PSMA PET scan.