My first PSA test after surgery

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 "

When it shows the < sign that means it is less than the laboratory's detection limit. The limit can vary a bit. My post-surgery testing was every 90 days, then reduced to every 6 months after a year of non-detects.

@rlpostrp
That is why the Surgeon’s that have pathology standing by to take the tissue and ink it immediately while your in surgery to check for positive margin is becoming more common. This clearly means having surgery at at major hospital or COE with in house pathology.

Exactly. That is especially true of things like skin cancers. It is less common with prostate, only because they seek to remove it all - the entire prostate - and do. But you're right. It would be nice to know that they could send your entire prostate to Pathology for quick frozen section to see if there are margins. I think too that the success of getting the entire prostate without surgical margins, which happens 90% of the time, lulls the surgeon urologist into think that they "did" get it all. Again, surgical margins only occur with about 10% of prostatectomies. My next appointment is on Wednesday. I'll ask why my urologist did not have a pathologist standing by. But...
One reason too for the surgical margins, is that the urologist is trying their best to remove the entire prostate while carefully dissecting and separating the neurovascular bundles from their attachment to the prostate. It must be akin to trying to get every piece of chicken off the bone when you're eating. Some people leave a clean, nearly polished bone without a spec of meat on it, and others leave quite a few fragment pieces of meat on the bone. Not the greatest comparative analogy, but I think you all get it.

@rlpostrp
I know it also then adds two more hours to surgery if margins come back positive. I was so fortunate my surgeon did.

Dang...I must have gotten the economy version radical prostatectomy. There have been SEVERAL things that I never knew and found out after the fact...like ED despite the neurovascular bundles "supposedly" being preserved, which continues now 15 months after surgery with nothing...not even a twitch...in my penis. My urologist is always really good asking me: "Do you have any questions?" The problem is, even with all of my knowledge and professional experience as the Director Clinical and Anatomical Laboratory in hospitals, you can't ask that which you don't even conjure as a possibility and know to ask.

@rlpostrp You are not alone. There was an interesting video posted with interviews with physicians who went through prostate cancer themselves. Unless their speciality aligned with prostate cancer, they were as clueless as most of the rest of us because of how specialized medicine is these days. (if anyone has a link to the video, please post)

After a couple of unexpected side-effect surprises post biopsy/PET scan, I realized I had to do my own research because the docs weren't telling me everything. I spent a ton of ton reading forums, online and "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" book.

Still incredibly grateful to this forum and the good people on it for all of their amazing advice.

I think in modern medicine, healthcare efficiency doesn't give most doctors the time it takes to explain everything. But, yeah, those were biggies like nerve sparing can take up to one year (potentially two) for any effect to kick in.

I'm sure you're familiar now, but have you pursued penile therapy?