What were the pathology descriptives on your surgical pathology report following prostatectomy? Did you have Extraprostatic Extension ("EPE"), If so, did it also say that you had "Surgical Margins"? If so, did it mention if cancer cells or nodules were found in one or both seminal vesicles and/or lymph nodes (if your urologist removed them)?
What I am getting at, is "did your urologist make you one of the "unlucky 10%" of patients with surgical margins, meaning that (s)he left cancerous tissue in your body? You can buy Dr. Patrick Walsh's book on Prostate Cancer. It is the "bible" of prostate cancer. It will discuss definitions and meanings of all of the terms. Basically, surgical margins is when the urologist, in their attempt to preserve your neurovascular bundles that are necessary for future erections and sexual activity, they make exquisite cuts, etc. to remove as much or all of the prostate as possible. But...if the tumor broke through the membrane that surrounds the prostate (EPE), the tumor starts to spread. The problem is the urologist can't always see or assume where it has spread. They cut and remove as much as they can get, but they may end up leaving some cancerous tissue inside your body (surgical margins) about 10% of the time.
Think of an apple that has a visible bruise. You take a knife and cut the bruise out. You hope/think that you got the entire dark bruised portion out of the apple. Then you slice the apple, and lo and behold, you still see some bruised tissue that you didn't get when you first attempted to remove it all. That is what surgical margins are like. In terms of your prostate, it may take a while, but that cancerous tissue, and actually any normal prostate tissue left with it, will slowly start to produce PSA. That is why we get our follow-up PSA every 3 months for the first year, and every 6 months thereafter until/if the PSA level starts to rise. It can take only a few months, or it can take decades. There was a gent on this blog 2-3 weeks ago who mentioned that after "25 (35?) years" his PSA started to rise. I was shocked that he went that long before his PSA started to rise.
So...you'll know immediately from the pathology report if there were surgical margins, but you will never really know if or when those cells start growing enough to produce test-detectable PSA levels. One thing my own doctor mentioned is that those cells need blood supply to survive. Part of the prostatectomy is to remove all blood supply.He said those cells usually and hopefully die before they find blood supply. What do I mean by "find blood supply"? Cancer cells can move/migrate..."crawl" if you will. The cell membrane can extend itself out in different directions in what are called pseudopods ("extensions"). They extend, and then kind of do what appears to "drag" the rest of the cell toward it. Actually the entire cell just incrementally moves toward the direction of the pseudopod(s). In one way, it is pretty cool science. I was a Cellular and Molecular Biology major and then went back to complete a second biology option in Clinical Laboratory Science. I was a director of Clinical Laboratory for over half of my career. The science behind what goes on in the human body is amazing. So...
If those surviving cells move toward existing blood supply before they die, then it now has a new blood supply to survive and multiply. When the cells multiple enough, they start being able to produce enough PSA that becomes detectable at the lower limits of detection of the PSA test assay. That is why the test results are reported as "