Yes, it happens, even many years later, and I am one example of that.

RARP in 2015. Pathology showed Gleason 3+4 with one positive margin. My Prolaris score also projected a 53% chance of a BCR at ten years.

I went ten years, getting regular PSA tests and DREs. PSA stayed below detection (< 0.1), and like you, I never thought much about it or fretted over it. In 2024, my urologist detected a small, palpable nodule in my prostate bed during a DRE, but my PSA was still undetectable. No action at that point.

In June 2025, my PSA rose to 0.11. PSMA PET and pelvic MRI scans confirmed that the nodule was cancerous, but there was no evidence of spread beyond that nodule.

In fall 2025, I underwent salvage radiation therapy (38 sessions of IMRT). My PSA at the start of radiation (ultra sensitive test) was 0.094. Effectively no change in the three months since June.

So far, so good. No lingering side effects from the RT. My first post-RT PSA test came back at 0.086 (again, ultra sensitive test). Likely that my PSA will continue to drop as the cancer cells die off (the radiation damages their DNA, so they die when the attempt to divide).

The odds of a recurrence after 3-5 years post-RARP go down significantly, but there are guys that have recurrences 20 years later. Also, the longer the time to relapse, the more likely the cancer is slow growing.

The best thing you can do for yourself is to keep up with your PSA tests…forever.