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Post Prostatectomy 6 years. PSA <.01 until now. Anyone else ?
Prostate Cancer | Last Active: 4 hours ago | Replies (74)Comment receiving replies
@melvinw
My concern has always been the level of 'high risk' that was diagnosed post surgery. Prior to surgery, my PSA was elevated (6) but stable for 3 years, so it was a 'wait and see'. Then it began to rise quickly with a doubling time of about 3 months. That is when the decision was made to act. I am hoping this is not a repeat of that scenario (i.e stability then surge). Your PSA of .09 seems low to have begun radiation. My impression was they do not consider a true BCR until .2 is reached? There seem to be so many opinion variations on this. I am a University of CA patient and they had said initially "if it goes up, we begin Lupron". That was 5 or so years ago so I am thinking they have adjusted thinking since then.
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@tom86 To flesh out my relapse, yes my PSA was low relative to the conventional cutoff of 0.2. The kicker was that in 2023, a small nodule was detected in my prostate fossa during a digital rectal exam. My PSA remained undectable until June of 2025, when it rose to 0.11. A PSMA PET scan was ordered and the nodule lit up with an SUMmax of 13.3. No evidence of distant mets. A follow up pelvic MRI was consistent with the PET scan, and also showed no lymph node involvement. Again, an anamolous situation given that PSMA PET scans have a relative low probablity of detecting cancer when PSA <0.5. Without the old school finger exam, I may well be on active surveillance with a little ticking time bomb. My salvage RT was an early intervention in one sense, but then it wasn’t just a BCR but a palpable lesion. My urologist and radiation oncologist both felt strongly the immediate therapy would increased the odds of success. I concurred.
Btw, my post-prostatectomy pathology was Gleason 3+4, Grade 2Tc, with one positive margin. Prolaris Score gave a 53% chance of BCR in ten years.
Hope your recent PSA bump is not the start of another surge. Seems the best any of us can do is to stay on top of monitoring, and make no assumptions about what is or isn’t coming next.
Yes, the use of ADT has evolved a good bit in the last five years, and continues to evolve. Radiation therapy has evolved as well. Huge brain trust here for all that.