Post prostatectomy: What do rising PSA levels mean?

Welcome to the Prostate Cancer group, @hoard.
You ask a good question. What can rising PSA levels means years after having had a prostatectomy?
There are several reasons why one's PSA level may rise after being stable for a time. This article explains it well:
- PSA levels after prostatectomy https://www.medicalnewstoday.com/articles/323899.php

Here's an excerpt from the article:
"Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.

In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include:
- older age
- ethnicity
- medication
A doctor will take these factors and the person's medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern."

The PSA test alone is not enough to determine cause or next steps. Your doctor will likely consult with your husband and possibly order other tests. How long ago did your husband have his surgery? Did he have other treatments after surgery? Do you have a followup appointment schedule with his oncologist?

Thank you! Relieves my mind somewhat! Next PSA in November..... long wait.

Hello @gcoley, Welcome to Mayo Clinic Connect. I can understand your concern and concern can be a good thing. Here's some information that may help understand the testing and followup.

Prostrate Cancer Foundation: https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/
Following PSA Levels During and After Prostate Cancer Treatment: https://www.cancer.org/cancer/prostate-cancer/treating/psa-levels-after-treatment.html

You mentioned your family physician didn't seem concerned. Are you able to ask the surgeon who performed the procedure about the rise in the PSA test numbers?

My surgeon retired 5 years ago. Thanks for the information.

I had a radical prostectomy in 2006. For the first 12-years after surgery, my psa was 0.01. A year ago it was 0.02. This year it was 0.1. My family physician didn't seem concerned. However, this rise has me concerned. After 14-years, is my cancer returning? What actions, if any, should I take?

I add my welcome @gcoley. You'll notice that I moved your message to an existing discussion where @hoard asked a similar question about rising PSA levels after a prostectomy. Please click VIEW & REPLY to scroll through previous posts. Allow me to repost info that I posted for @hoard

There are several reasons why one's PSA level may rise after being stable for a time. This article explains it well:
– PSA levels after prostatectomy https://www.medicalnewstoday.com/articles/323899.php

Here's an excerpt from the article:
"Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.

In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include:
– older age
– ethnicity
– medication
A doctor will take these factors and the person's medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern."

The PSA test alone is not enough to determine cause or next steps. Do you have a followup appointment schedule with your PCP or oncologist to discuss?

Is an MRI of prostate effective to show stages?

The MRI can assist in corroborating the extent to which the cancer has spread both within the prostate and possibly outside the capsule, helping to determine the course of treatment -- surgery, radiation, ADG, etc. However, a prostate biopsy is required to determine the areas impacted by the cancer cells and the relative rate of "aggression" in each area. The biopsy results then provide Gleeson scores that are indicative of the cancer "rating" in each area, and are critical to the determination of how and where to treat the cancer within the prostate gland.

Hoard,glad you all joined. Short answer: too many variables/patient. Recommend seeing your providers for the best, most reliable information for your husband. All the best...
Mike C.

I have question regarding stage 3b prostrate cancer. In November of last year I was diagnosed with stage3b prostrate cancer. I was told that the cancer had not spread and that a radical prostectomy was all that was necessary. Everything I have read stated that stage3b has spread to some surrounding tissues. Just 6 months later I’m told that the cancer has metastasized and spread. My question is this. Should radiation and/or hormone treatments have been advised before the cancer went to stage 4? Thanks for any information.