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Following a prostatectomy, they typically wait 3 - 4 months until the first PSA test to allow time for PSA remnants to fully leave the bloodstream. After that, PSA should always remain (at least nearly) undetectable.
At just 7 weeks post-surgery, a PSA of 1.0 is not unusual and indicates the likelihood of remnants of PSA still in your blood. (Your urologist should be aware of this.)
If you wait a couple of more months, and repeat the PSA test, you’ll likely find that your numbers are good. At the very least you’ll know that you’ve given it an appropriate amount of time.
Hold off on the radiation+hormone therapy discussion until after that 3+month PSA test.
As for what to do about the ED, here’s a 2023 presentation out of Stanford University that’s titled “Penile Rehab: Optimizing Recovery of Erectile Function after Prostate Cancer Treatment.” They talk about things to do before and after surgery to help with ED issues: https://youtu.be/aRp1NXjPGLE
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@brianjarvis wrote "At just 7 weeks post-surgery, a PSA of 1.0 is not unusual and indicates the likelihood of remnants of PSA still in your blood."
I don't believe this is accurate. But I'd be happy to be corrected if you have sources that support a different interpretation.
All the sources I've seen put the half-life of PSA after radical prostatectomy at approximately 2 to 3 days. (Example: https://www.urotoday.com/conference-highlights/apccc-2026/168594-apccc-2026-psa-persistence-or-recurrence-after-radical-prostatectomy-when-and-how-to-react.html notes that "the total PSA half-life is 2.7-3.3 days" and defines persistence as a PSA of >0.1 at 6 weeks post-RP.)
With a pre-op PSA of ~18, @djkurr 's PSA should have dropped below 1 after about 5 half-lives, or roughly 10-15 days. By 6 weeks after surgery, his PSA should be undetectable if all the cancer were removed.
I'm not trying to be alarmist, but the facts presented suggest either lab error in that 1.0 result (or a misunderstanding by djkurr) or persistence, which would warrant attention by the oncologist. It's misleading to suggest that a PSA of 1.0 six weeks after RP is in any way normal here.
@djkurr , did you have a PSMA PET scan prior to surgery? Were any lymph nodes removed and examined? It would also be helpful to know what your post-op pathology report said.
But you should start reading up on adjuvant radiotherapy+ADT and be prepared to discuss with your oncologist whether that would be appropriate for you. It's not indicated for men who have low or undetectable PSA after surgery, but can yield life-saving outcomes in cases of persistence when extra-prostatic cancer was missed.