Rising PSA immediately following RP

Yeah, my PSA was .36 4 weeks after RP, .56 at 8 weeks, .82 at 12 weeks. Doc wants mr to start ADT then Radiation; Im hesitant due to side effects; still trying to decide

@kede02026 Better decide quickly, as your window for successful treatment has already passed its upper limit of 0.70 or so.
Orgovyx is a miracle drug and will STOP the PSA in its tracks, side effects be damned.
Phil

@bob65 and @kede02026
"Anyone else go through something similar?"
Yes, I did. I'm kind with the majority here, it's time to DO SOMETHING. Analysis paralysis can bite you on the butt here.
My timeline was this...
09/02/21 Operation
01/26/22 PSA Result of 0.039
04/26/22 PSA Result of 0.091

The doctors were adamant it was time to jump in with SRT and ADT (orgovyx in my case)

39 sessions and two years of Orgovyx later....(off it now)
06/03/24 PSA Result of <0.006

..and been that way since that date. (knocks wood) I'd suggest it's time for action on this.

"I feel defeated" You're not defeated until you give up! FIGHT ON!

Best of luck to you!

It's a shame to hear so many people that have RP end up needing radiation anyway. I've read it could be as much as 40-50% end up needing radiation at some point after having the prostate removed. Plus I have read long term treatment success is about the same as RT. I would think it would be much easier to decide on RP if those odds were better, but at up to 50% it's almost a coin flip. Keep fighting! Wishing you the best

1. Were your PSA tests performed by the same clinical laboratory? It is usually only very subtle differences that are seen when someone has their testing done by/at different labs. Your PSA value has essentially doubled and in a very short time. That would only happen if you have prostate tissue remaining in your body "somewhere."
2. I would ask to have you surgical pathology slides of your prostate tissue sent to Mayo Clinic or another reputable university-based teaching medical center where the best urologists, and more importantly "best pathologists" are who see tons of prostate cancer cases. PSA is only produced by prostate tissue.
You say that your "margins were clean" (no "surgical margins) and your disease was "contained" to the prostate, which means no Extraprostatic Extension (EPE) that could have seen prostate tissue left behind in your body. The only way that your PSA could be rising after your prostate was presumably 100%, entirely removed, is that prostate tissue WAS actually left behind...and that does not match your surgical pathology report. You need a fresh pair of HIGHLY skilled pathologist's eyes looking at your all of your prostate tissue slides again, to yield their own report. With a clear PET scan and MRI, that should mean that the disease was confined to the prostate, without any radiation detected in your lymph nodes or bones. This all does not make any sense. It is almost like your slides were mislabeled...your slides were labeled with another patient name, and your name was put on someone else's slides (this CAN happen in labs with poor procedural quality control, that are processing multiple patient samples at the same time). it is ULTRA rare, but it could have happened. Update us after you have your slides re-read. Good luck!

@rlpostrp

That is not true. Cancer in very small amounts can not be seen on scans, not even PSMA.

Cancer cells can escape prostate gland well before surgery via blood, lymphatic system, neural bundles etc. That way micro metastasis are established and can start growing on their own in proximity or in distant places.

There are many , many patients here with negative margins and intermediate, gleason 7 cancer that ended up with BCR. That is absolutely not an anomaly.

On the other side, there are patients with positive margins, EPE and gleason 9 who did not have BCR in many years post op.

With PC there are just NO rules and no certainty.

@rlpostrp I think it’s more the velocity, than the value in this case.
My urologist said that normal - even hyperplastic - Prostate tissue left behind does not have real fast doubling time. Best,
Phil

@kede02026
As understand it, your condition means the cancer slipped out of the prostate before prostatectomy. There's a good chance it's still very localized ie still in the prostate bed. You might ask your Docs about getting a PSMA PET scan to get a better handle on it. But at this early stage it might simply reveal what the Docs already have expertly surmised that it's still in the fossa and they want to hit hard and fast with both radiotherapy and a short course of ADT before it moves further up or down stream. It could be in a stage where it's still curable which may explain why your Docs want to go now. Time may not be your friend here.

@copyman
About 30% (low risk) - 50% (high risk) of RT patients have BCR also, so results are the same in that way too.

My husband is high risk and had BCR after RP and he would still choose RP as initial step since it gave him clear picture of actual gleason (which was upgraded post RP) and also gave him possibility to catch very early BCR which can easily be obscured for RT patients with PSA "bouncing". Now he has an option of localized RT which would otherwise be out of picture if he already had RT.

His RP recovery was super fast and super easy with full continence and minor ED. So - no method is full proof and no method is ideal or superior. Both can have great success and both can have BCR and both have possible SA that can effect quality of life.

Hi Bob65,
In the same boat. Gleason 9, 58 and went through RP, some cancer in the margins and lymph nodes. Did the radiation as soon as I healed from surgery (it’s not bad) and now on ADT until at least January. Hang in there! It’s a fight for your life, even though sometimes the cost seems unbearable. If we are lucky we live to retire and have a few good years. I just want to live to wake up without an alarm 🙂
I do it for my wife, I bought a snowmobile for me, and try to be as positive as I can. It sucks but you are not alone and will get through this. It might kill us in the end, but not today. If you ever want to chat let me know-sounds like we have much in common unfortunately.