PSA detected after salvage radiation and prostectomy

Ouch @aprapr , I have same situation. RAPL 2022, then PSA rised to 0.2 at 2024. ADT 6months and Salvage Radiation 33times. No positive scans. Spring 2025 PSA undetectable. November 2025 PSA 0.1! Urologist informed next scan within 3 months and new operations(?) if the PSA is still up/rising.

@restlessandwild just wondering if you retested yet, and what your results were?

@foreright late January increased to .13. Husband Retested again late March and decreased to .11. No ADT yet. Currently monitor mode. Seeing medical oncologist again in June. New scans scheduled for August.

@restlessandwild just wondering if you retested yet, and what your results were?

@aprapr Sounds like you have a good plan. I know your anxiety all too well, but also a PSA of 0.11 means you are on it as early as can be, if it is a BCR.

Dr. Patrick Walsh’s ‘Surviving Prostate Cancer’ book has some very informative tables in Chapter 12 regarding metastasis risk and odds of not dying from prostate when PSA rises after primary treatment. In your husband's case, the Gleason 7 score, the long time to recurrence (>3 years), and PSA doubling time greater than 9 months are all heavily in his favor. For example, with Gleason score < 8, recurrence >3 years after surgery and PSA doubling time of 9 to 14.9 months, the odds of not dying from PCa are 95% according to those tables. And those tables use data from men who did not benefit from all the technological advances of the last 5-10 years.

May the Odds Be With You and Your Hubby!

@melvinw

\\Dr. Patrick Walsh’s ‘Surviving Prostate Cancer’

I was looking for the 5th edition of this book but couldn't find it. Do you by any chance have it?

Did your husband's post-surgical pathology report reveal and detail any of the following:
1. Extraprostatic Extension (EPE) where the tumor broke through the membranous "capsule" of tissue that surrounds the prostate?
2. Surgical margins where cancerous cells were viewed microscopically right up to the edge (margin) of the tissue? That means that the cancer extended beyond what was removed...the urologist couldn't have know it, but (s)he left some cancerous tissue in your husband's body.
3. Seminal vesicle invasion of one or both seminal vesicles. Both were removed along with both vas deferens, but when the cancer is found in the seminal vesicle(s), it instantly takes you to the pT3b tumor classification, independent of the lower risk Gleason of 3+4=7. I know, because this was my reality. A pT3b cancer has a 25-50% probability of recurring "within" the first five years post op. My urologist said that in his practice 1 of 3 (33%) of his pT3b patient have recurrence "within" five years. I am hoping, praying, and counting on being in the 2/3 that don't have the recurrence.
The real pivot point for prostate cancer seems to be Extraprostatic Extension. Once the tumor breaks through the capsule, all bets are off because you don't know where it is spreading. The likely places are the seminal vesicle(s), and that is why they are removed in cautionary surgical practice. Sometimes the cancer spreads to the bladder neck, or lymph nodes that are close by.
I'll look for your reply. Good luck to you and your husband.
Hopefully there will be enough prostatic tissue for a PET Scan to see radioactive isotope (Gallium) uptake and where it is. Prostate cancer grows so slowly (most of the time) that your PSA can be detected, but there may not be enough cells to take up the Gallium isotope for the PET Scan to detect it.
Please reply back with whether your husband had any of the above (1-3).