PSA INCREASE - IS IT OK?

With radiation you still have a prostate that can produce some PSA. Levels below 0.2 are not even considered recurrence for RP patients. All of those are well within error variance. Your PSA is still well below what it was a year ago (.344). The standard for radiation recurrence is a 2.0 increase. Should act before that level but right now you are getting noise. Continue to monitor.

What Jim said^^^^^^^^^^^^^. With radiation treatment, nadir is considered to be the lowest PSA reading after therapy which in your case looks to be 0.136. Recurrence is typically defined as nadir +2.0 so 2.136. As Jim also said, I wouldn't wait quite that long but you have a way to go before anything close to concerning. Keep the quarterly testing but park cancer on the back burner and enjoy life.

We had similar numbers: About 5-1/2 years ago at 65y, 7(4+3), PSA of 7.976. I had proton radiation + 6 months of ADT. I’m 71y now.

A few questions:
> what was your pre-treatment PSA?
> what is your testosterone level now?
> did your MRI or biopsy reports mention anything about extracapsular extension, seminal vesicle invasion, perineural invasion, cribriform pattern or intraductal carcinoma?
> while you were on ADT, how low did your PSA go? (Mine dropped to <0.008 ng/mL.)

There seems to be little to be concerned about. Your numbers are still low, and should eventually settle within a “new normal” low range, since you still have a healthy prostate producing PSA. (My most recent PSA was 0.366 ng/mL.)

I am confused about the term NDIR. From my understanding it means lowest point, so if I had a PSA of lets say .02 and then a few years later a PSA of .07. Wouldn't my NDIR be .02 the lowest PSA level I ever had?
Nadir is a medical and general term meaning the lowest point.

@diverjer - Not quite sure why you're confused. what you said is correct. In the OP's case, nadir was 0.136 in January 2026.

@jim18 Thanks for your reply, that is my thinking.

@brianjarvis Thanks for your reply and questions.
Pre-treatment PSA 7.3
Testosterone level- don't know.
None of those you mentioned were in the biopsy reports.
While on ADT, PSA dripped to 0.006.

Best of luck.

@mjp0512
I am easily confused in this area. I didn't think nadir had much of anything to do with recurrence . I read where it is recurrence by one organization at .1 and another organization says at .2. Now I think I see why this is important. I can see why it would be something to really watch if PSA doubled the nadir or was climbing fast above the nadir. But would a person want treatment if PSA was still below .1? I guess you might, that would be a good discussion with patient and physician. I believe I would be concerned of I doubled my nadir in a period of time. Now I see that you need to watch for more than just the .1 or .2.

@cochuir The only recommendation would be to track testosterone and full bloodwork with every PSA test, that way you’ll know if anything is trending in the wrong direction and can take quick action if it does.

And get a genetic (germline) test if you have the opportunity.

@diverjer The 0.1 or 0.2 thresholds for recurrence are after surgery, since PSA has to be essentially zero. After RT the criterion is nadir plus 2.