Post prostatectomy: What do rising PSA levels mean?

Hello @numnuts, Welcome to Mayo Clinic Connect. I see that you also posted the same question in the Stage3b Prostrate cancer discussion. I'm not sure anyone can answer your question as we are not medical professionals or doctors. I did find some information on the American Cancer Society website that may be helpful for you.

Initial Treatment of Prostate Cancer, by Stage: https://www.cancer.org/cancer/prostate-cancer/treating/by-stage.html

Have you started a new treatment?

I am surprised they did not start hormone therapy. That is pretty standard whether you decide to go with radiation or surgery is my opinion. I started ADT hormone therapy as soon as my cancer was staged.

New Prostate Cancer Patient. Had my Prostatectomy 3/3/20. On 4/20/20 my PSA was 0.068. Today 7/23/20 my PSA test 0.127. My Dr wants me to consider Radiation Therapy to prevent possible spread. Should I wait until PSA is above 0.2.

You should check those PSA numbers. My number is currently undetectable (4 yrs post surgery) and is quoted as <0.10ng/ml. This is the lower limit of detection of the test. Your 0.068 and 0.127 numbers may not be different and could both be at the lower limit. It is not a good idea to start radiation until you are sure of the need for it since it can have significant side effects. Also, I recall that PSA has a fairly long half life and it takes about 8-10 weeks to get a reliable number while the amount already in the blood decays. I'm not sure of the half life but your doctor should know and then you can do a simple calculation based on your pre-op PSA number to see when it should be undetectable.

Hello @brownhome1, I would like to add my welcome to Connect along with @horace1818. Here's some information I found that I hope may be helpful.

Excerpt from link below..."After the surgical removal of the prostate, or prostatectomy, PSA drops to virtually undetectable levels, (less than 0.1), depending on the lab performing the PSA test. ... Following a prostatectomy, the most widely accepted definition of a recurrence is a confirmed PSA level ≥0.2 ng/mL."

Is Your PSA Rising? | Prostate Cancer Foundation: https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/psa-rising/

You mentioned your doctor wants you to consider radiation therapy. Are you able to discuss your concerns with the doctor about waiting to see if the PSA goes higher?

The half life of PSA in blood seems to be about 3 days. Your value at any time after prostatectomy will be dependent on your last number before the surgery. If it was 20, then, assuming none is now produced, it will drop every 3 days to 10, then 5, 2.5,1.25, 0.63, 0.32, 0.16, 0.08 and so on. So, it will take at least 8 cycles of 3 days = 24 days, to be below the limit of detection of 0.1ng/ml. In other words, it takes a month to stabilize. See this reference:
https://www.google.com/search?q=psa+half+life+calculator&oq=PSA+half+life&aqs=chrome.1.0l6.9532j1j4&sourceid=chrome&ie=UTF-8

Excellent and objective info. Thanks for sharing!

Hard to answer whether radiation treatment is needed without knowing if the cancer has spread beyond your prostate. My inference is that it has. Typically the surgeon biopsies adjacent areas to the prostate when performing the prostatectomy. An MRI, while effective at identifying areas impacted by the cancer, is not 100% accurate, i.e., it can miss cancer cells. If the cancer has spread beyond the prostate based on conclusions from the biopsy, radiation may be in order, even though the surgeon will try to remove the additional areas impacted beyond the prostate during the surgery ("to get it all"). Typically, as one writer mentions, ADT treatment is recommended for a period of time post-surgery to further ensure that the cancer does not reoccur -- testosterone is the fuel that feeds the cancer fire. ADT suppresses production of the hormone. A rising PSA is a yellow flag unless it continues to rise over time. Hence, no immediate action may be required. For example, if radiation therapy only is used to treat prostate cancer, a "spike" in PSA isn't uncommon, only to return to an acceptable level at a subsequent test.

I had a prosectamy in 2005 and my PSA has been rising slowly. I was at 0.44 6 months ago and now 6 months later it’s 0.56. It has slowly going up. I am 70 years old now. What do you think of this?

Hello @ira817, Welcome to Mayo Clinic Connect. I found the following information on the Cancer.gov site that may be helpful explaining the PSA numbers.

"In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.Oct 4, 2017"
- Prostate-Specific Antigen (PSA) Test - National Cancer Institute: https://www.cancer.gov/types/prostate/psa-fact-sheet

Have you discussed the latest PSA test results of 0.56 with your doctor?