Slight rise in PSA 24 years after radical prostatectomy!

@domiha Glad to share my experience. And I agree, you have a big IF in all this. Best wishes, Mel

@domiha You always need a biopsy at some point. The PSE test is often used to decide if you want to go forward with a biopsy.

I would suggest contacting a teaching hospital that has a nationally recognized cancer center. I am so over private urology and radiology practices. Looks like Emory is an NCI cancer center. Best wishes on your journey.

@domiha There have been a few discussions here about viruses like Covid, which can reactivate dormant cancer cells after decades.
Not to say that they make them more aggressive, but it could be that some of those G3+3 cells were snoozing in the prostate bed all these years and now they’ve awakened.
Interesting that your PSA, stable for so many years chose to rise in the years following Covid. Reflecting back on my own case, my PSA was fairly stable at 0.01 for about 3 years following surgery and then it began to climb during Covid (yes, I got the vax) and really accelerated after getting a nasty 2 week long bout of the virus. Only now can I connect the dots!
Even if you didn’t have the obvious sore throat, cough and body aches most of us experienced, you could have had an asymptomatic case…who knows?
I second the recommendation for getting a PSE test. Best,
Phil

Mike

Thus may be of interest in making any decisions...
https://ancan.org/playing-the-long-game-does-your-recurrent-advanced-prostate-cancer-need-treating-nci-seminar/
Kevin

@kujhawk1978 Thanks for sharing, Kevin! Great source of information!!
Mike

@heavyphil Something I had not considered. Got the first vax in January of 2021. Then, at Christmas 2021 got Covid, with the terrible sore throat like swallowing glass. Lasted about a week. Thanks for bringing this up. One more thing to add to my list of questions for the doc.
Best wishes!
Mike

@domiha I'm a bit confused by your numbers. The LabCorp ultrasensitive PSA goes down to < 0.006, so if you just popped up over undetectable, that would be 0.02, not 0.2. [Here's some of my sequence: after surgery 2/27/22 from 0.012 8/22, 0.016 11/22, 0.012 2/23, [exclude < 0.006 6/23,] 0.020 12/23, .016 4/24, .019 10/24, .021 3/25, 10/25 .023 ng/mLs.]

So if you've been getting the uPSA as is recommended after prostatectomy, you are way over the bottom of the scale at 0.20 ng/ml, like by an order of magnitude (10x) and you are at the level identified as biochemical recurrence. However a PETscan is still quite iffy for detecting at this level. Here is an AI summary:
"PSMA PET scans are highly effective at detecting recurrent prostate cancer, with sensitivity increasing alongside PSA levels. Detection is possible at very low levels, typically >0.2 ng/mL, with rates rising from roughly 38%–58% (at < 0.5 ng/mL) to over 90% when PSA is >2.0 ng/mL.
Key Detection Ranges & Rates
PSA < 0.2 ng/mL: Detection is possible, with studies showing a roughly 34%–42% success rate.
PSA 0.2–0.5 ng/mL: Detection rates improve to roughly 38%–65%.
PSA 0.5–1.0 ng/mL: Detection rates rise to about 57%–75%.
PSA 1.0–2.0 ng/mL: High detection rates, often above 75%–84%.
PSA > 2.0 ng/mL: Very high detection rate, usually >90%–95%.
Factors Influencing Detection
Timing: A PSA of 0.5 to 0.9 ng/mL is often recommended to maximize detection after radical prostatectomy and radiation.
PSA Doubling Time: A faster rise (shorter doubling time) increases the likelihood of a positive scan.
Methodology: PET/MRI scanners may show slightly higher sensitivity for very low PSA levels compared to PET/CT. "

This is quoted from https://www.labcorp.com/tests/010322/prostate-specific-antigen-psa:
"According to the American Urological Association, serum PSA should decrease and remain at undetectable levels after radical prostatectomy. The AUA defines biochemical recurrence as an initial PSA value ≥0.2 ng/mL followed by a subsequent confirmatory PSA value ≥0.2 ng/mL." Interestingly, they have exactly the same language in the description of the uPSA: https://www.labcorp.com/tests/140731/prostate-specific-antigen-psa-ultrasensitive

A PSMA PET scan is your next step. But if the mets are too small, they will not register. If you do ADT, these small mets will never grow to a size where PSMA PET scans can pick them up. But you will be on lifelong ADT which is clearly no fun. Post surgery, a PSA rise to 0.2 is enough to trigger a salvage protocol. But after 23 years?

This is probably my single biggest fear, RARP at 54 and 20 years later it rears its ugly head again. My thoughts and prayers are with you that this is an easy fix!