How do you fight anxiety from rising PSA?

I definitely missed the fact that you had radiation after the surgery. Once you’ve had that radiation, they can’t radiate that area again. Usually, the rising PSA is a result of cancer somewhere else. As others have said a PSMA PET scan is the way to go First. The problem is that .2 you are unlikely to be able to have anything seen in a scan. I know somebody that was having them every three months when they had .2, So some doctors feel, they can find something eventually. If they do find a metastasis, they can zap it with SBRT radiation unless it is near some delicate organ.

Since you’ve had radiation, they’re probably going to wait to see what your doubling rate is rather than do something right away. Getting a PSA test to find out how quickly the PSA is rising, tells a lot more than a PSMA Pet test that is unlikely to show anything.

I’ve been where you are right now. Having my PSA rise after a prostatectomy and radiation. I’m 12 years past that radiation and had three more reoccurrences, but the drugs have worked very well. I have the BRCA2 genetic problem, which makes my cancer more aggressive, and I’m still around. Your chance of living decades longer is very good even though your PSA has shown a small rise.

If you are still on Lupron and your PSA is rising, you are becoming what is called castrate resistant to ADT. That happened to me 2 1/2 years after having salvage radiation. I was put on Biclutamide For a year and then Zytiga for 2 1/2 years. That kept my PSA down for a long time. I then switched from Lupron to Orgovyx And started taking Nubeqa. That is kept my PSA undetectable for the last 29 months. Just an example of how the drugs can help.

@jeffmarc thank you for your comment you actually eased my anxiety a bit. Knowing someone has gone thru the same situation is very helpful. Again thank you

For me, anxiety is a feeling of things threatening from outside of myself. (True for anything, but it goes double for PCa.) I try to bring it "inside", and gain a measure of control, by putting it on a sort of psychic workbench where I can work on it and have some impact. It involves examining what I know objectively, getting answers for what I don't know, building defenses (exercise is big here), gathering support from friends and loved ones. It takes some effort to keep steering myself back to this state of mind, but it works. You rose up and asked the question - a big, hopeful first step. Good luck!

There has been a radio commentary/ad running on a local Los Angeles radio station quoting a reporter who speaks of having started her day on the day of the Altadena "Eton" fire in January 2025, and ending her day being a victim of it, having lost her own home in the fire. She says (paraphrased): "I had to accept that feeling 'Not OK' was my new normal, and not being OK 'was' normal (in stressful, life altering situations), and therefore OK." I liked that. I didn't expect it to help me but it did. For over a year I have offered my metaphorical analogy here on this Mayo blog of: "I'm walking around everyday with a black raven on my shoulder (a.k.a. my anxiety-ridden, post-prostatectomy life of watch and wait), that pecks at me to remind me that it is there, and that one day it is going to kill me." The radio reporter's comment helped me realize that you have to keep moving forward, hoping for the best, and accepting what happens that we cannot control. That reminded me of another humorous but "real" quote from the movie "A Passage To India" (1984) where in a moment of great stress for one character, an Indian mystic says: "You can do what you want, but the outcome will be the same." I laughed in the movie in 1984, and in the few times I've rewatched it, it still makes me laugh because it stops the anxiety-ridden character in his tracks and puts things into perspective. It is another version of "what will be, will be"...you have no choice in the matter except one: how you react, because your reaction is your "choice", so choose what is best for you in that stressful, anxiety-ridden moment. And, my final awareness with both the Eton fire story and the movie quote, is that you need to give it to God. If you have faith, then give it all to God who will strength you, comfort you, and guide you. If you don't have faith...maybe this is the time to seek it. He wants a relationship with you...He is waiting.

@guybe thank you for your comment, for me when I saw the number it was like a dark cloud came over me and I thought “ I have to deal with this shit again” I felt I couldn’t get away from it, then I found this group and found someone who was going thru the same thing as me and it felt not so scary, it was like I was going into the cave of the unknown but I found someone who had entered before me and they said it’s ok going this far in,idk it’s hard to explain but I like your analogy on putting it on a workbench and examining it for what it is. It’s hard sometimes but I’m not going to let it get me down to far it’s not a good place to be, I’m still alive , I have options, I love to travel so that’s what I’m going to keep doing ,live like there’s no tomorrow because all we have is the now……wow I just gave myself a pep talk, and I think it’s working

Instead of fighting, consider making a little space for the anxiety in your life.

Since 2021, I've been learning to live with "incurable" stage 4b prostate cancer. The worry will never disappear, but it doesn't prevent the rest of my life from being great.

And you're still *very* early on the treatment path. After you've had your imaging, your oncologist may simply recommend adding an ARSI — one of the -lutamides or Abiraterone — to your Lupron. If there are a couple of detectable metastases on the imaging, they can zap those with radiation. Then you just get on with your life. ❤️

I'm still in my first round of treatment, so I can't speak to your experience exactly. I do find that taking reasonable actions following the directions of a trusted specialist, with inputs from forums like this, helps reduce anxiety. I am also taking weekly sessions with a counselor to guide me to healthy responses to stress. All the best!