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Rising PSA immediately following RP

Posted by bob65 @bob65, Sep 23, 2023

Anyone here experience rising PSA on first test after RP? I am 57 years old. I was diagnosed in April with PSA of 35. PMSA Pet and MRI were clear. Biopsy Gleason 8. RP in June. Clear margins, cancer contained to prostrate. Raised to Gleason 9. PSA last month was .17 at 8 weeks. Followup PSA last week is 1.5. I was hopeful surgery was successful or would at minimum give me a number of years without treatment. I have PMSA scheduled next week and a consult next month. I feel defeated. Am I going to be actively battling this the rest of my life? I am just starting to feel like myself after surgery and now will likely have to start another treatment. Anyone else go through something similar? Did the subsequent treatment work and give you some quality of life time without being in active treatment? I imagine I’m looking at hormone therapy and radiation.

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chippydoo | @chippydoo | May 27 9:46am
In reply to @surftohealth88 "@rlpostrp That is not true. Cancer in very small amounts can not be seen on scans,..." + (show)
Profile picture for surftohealth88 @surftohealth88

@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.

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@surftohealth88 Well said. One can go 10 years free and clear and then bang it's back. That's one reason some doctors are allowing PSA to rise to the 1-2 level as they feel they can find it and zap it. Takes nerves of steel to make that choice.

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clevelandguy | @clevelandguy | May 28 8:23am

Hi,

PET scan is a great idea but sometimes the scan does not catch very small cancer growths. Monitoring your psa looking for a generalized upward trend is very beneficial. Some doctors after a negative PET scan will want to just to irradiate the general area where your Prostate was. Using radiation that could impact your bladder and rectum is kinda scary to me. If it was me I would wait til it showed up on a PMSA PET scan first, but that’s just me.
Dave 3+4

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