Post prostatectomy: What do rising PSA levels mean?

It's your choice, but...with a PSA of 2.5 after surgery instead of <.1 it means your PCa was advanced, outside of the prostate, possible the lymph nodes, though not impossible to include bone or organs. Was there any imaging done o try and determine where the recurrence was after surgery. Since you had surgery, you have a pathology report, sharing that with the forum will help members with their advice. In My case, it was T2CNoMX, SV, ECE, Margins negative, GS 8.

From what you say it seems your had SRT, was it to the prostate bed only or did it include the PLNs?

Al this is irrelevant now, question is, what to do now...

First, I would ask your medical team to schedule imaging to locate the site(s) of your PCa. At your PSA, any of the FDA approved ones will likely determine where it is.

You can have your PSA checked again, 30-90 days, it would tell you whether or not the rise is a continuous upward trend or a increase that can occur after radiation and then it goes down.

Informed by clinical data - your pathology report, PSA results which can be used to calculate PSADT and PSAV and the imaging, you and your medical team can make a decision on treatment, if, when to initiate and what. If your decision is to treat, you will have choices so consider what the clinical data tells you but most likely monotherapy will not be the answer, you will want to consider a combined regimen.

Kevin

It's your choice, but...with a PSA of 2.5 after surgery instead of <.1 it means your PCa was advanced, outside of the prostate, possible the lymph nodes, though not impossible to include bone or organs. Was there any imaging done o try and determine where the recurrence was after surgery. Since you had surgery, you have a pathology report, sharing that with the forum will help members with their advice. In My case, it was T2CNoMX, SV, ECE, Margins negative, GS 8.

From what you say it seems your had SRT, was it to the prostate bed only or did it include the PLNs?

Al this is irrelevant now, question is, what to do now...

First, I would ask your medical team to schedule imaging to locate the site(s) of your PCa. At your PSA, any of the FDA approved ones will likely determine where it is.

You can have your PSA checked again, 30-90 days, it would tell you whether or not the rise is a continuous upward trend or a increase that can occur after radiation and then it goes down.

Informed by clinical data - your pathology report, PSA results which can be used to calculate PSADT and PSAV and the imaging, you and your medical team can make a decision on treatment, if, when to initiate and what. If your decision is to treat, you will have choices so consider what the clinical data tells you but most likely monotherapy will not be the answer, you will want to consider a combined regimen.

Kevin

It's your choice, but...with a PSA of 2.5 after surgery instead of <.1 it means your PCa was advanced, outside of the prostate, possible the lymph nodes, though not impossible to include bone or organs. Was there any imaging done o try and determine where the recurrence was after surgery. Since you had surgery, you have a pathology report, sharing that with the forum will help members with their advice. In My case, it was T2CNoMX, SV, ECE, Margins negative, GS 8.

From what you say it seems your had SRT, was it to the prostate bed only or did it include the PLNs?

Al this is irrelevant now, question is, what to do now...

First, I would ask your medical team to schedule imaging to locate the site(s) of your PCa. At your PSA, any of the FDA approved ones will likely determine where it is.

You can have your PSA checked again, 30-90 days, it would tell you whether or not the rise is a continuous upward trend or a increase that can occur after radiation and then it goes down.

Informed by clinical data - your pathology report, PSA results which can be used to calculate PSADT and PSAV and the imaging, you and your medical team can make a decision on treatment, if, when to initiate and what. If your decision is to treat, you will have choices so consider what the clinical data tells you but most likely monotherapy will not be the answer, you will want to consider a combined regimen.

Kevin

Good afternoon! I apologize upfront for the lengthy post. I'm trying to wrap my mind around the whirlwind of my husband's (age 51) recent diagnosis of prostate cancer that was suprisingly found during his colonoscopy. Prior to the colonoscopy, my husband had a PSA of 3.1. His primary never suggested further testing because of it. During his routine colonoscopy, the GI came out to talk to us to let us know that he found a nodule on prostate during exam and sent referral to urologist. After appointment and finally biopsy, it was determined he had prostate cancer. Multiple Gleason 3+4 and one core 8 on biopsy. Also perineural invasion present. Had prostatectomy in 11/20. First post PSA .1 in 2/21. Had followup PSA in 5/21 was .6. (Physician wanted to retest due to recent COVID vaccine). Had another PSA on 6/21. This time was .7. He was sent for PET scan this past Friday which came back negative. Urologist referred to in house radiation oncologist. Appointment was yesterday. I asked nurse before he came in if my husband has radiation now could he have it again down the road if there is recurrence. She said that would be a question for the doctor. When he finally came in the room, the first words from his mouth were "this is his best, last chance." Needless to say, my husband and I both were in complete shock.... I have since contacted Moffitt and we have an appointment Tuesday. Has anyone had a rising PSA so soon after surgery? If so, what type of additional treament did you have? While hearing cancer is terrifying, we did not think the outlook was terrible until our visit with the physician yesterday. Any insight would be greatly appreciated.

Good afternoon! I apologize upfront for the lengthy post. I'm trying to wrap my mind around the whirlwind of my husband's (age 51) recent diagnosis of prostate cancer that was suprisingly found during his colonoscopy. Prior to the colonoscopy, my husband had a PSA of 3.1. His primary never suggested further testing because of it. During his routine colonoscopy, the GI came out to talk to us to let us know that he found a nodule on prostate during exam and sent referral to urologist. After appointment and finally biopsy, it was determined he had prostate cancer. Multiple Gleason 3+4 and one core 8 on biopsy. Also perineural invasion present. Had prostatectomy in 11/20. First post PSA .1 in 2/21. Had followup PSA in 5/21 was .6. (Physician wanted to retest due to recent COVID vaccine). Had another PSA on 6/21. This time was .7. He was sent for PET scan this past Friday which came back negative. Urologist referred to in house radiation oncologist. Appointment was yesterday. I asked nurse before he came in if my husband has radiation now could he have it again down the road if there is recurrence. She said that would be a question for the doctor. When he finally came in the room, the first words from his mouth were "this is his best, last chance." Needless to say, my husband and I both were in complete shock.... I have since contacted Moffitt and we have an appointment Tuesday. Has anyone had a rising PSA so soon after surgery? If so, what type of additional treament did you have? While hearing cancer is terrifying, we did not think the outlook was terrible until our visit with the physician yesterday. Any insight would be greatly appreciated.

Good afternoon! I apologize upfront for the lengthy post. I'm trying to wrap my mind around the whirlwind of my husband's (age 51) recent diagnosis of prostate cancer that was suprisingly found during his colonoscopy. Prior to the colonoscopy, my husband had a PSA of 3.1. His primary never suggested further testing because of it. During his routine colonoscopy, the GI came out to talk to us to let us know that he found a nodule on prostate during exam and sent referral to urologist. After appointment and finally biopsy, it was determined he had prostate cancer. Multiple Gleason 3+4 and one core 8 on biopsy. Also perineural invasion present. Had prostatectomy in 11/20. First post PSA .1 in 2/21. Had followup PSA in 5/21 was .6. (Physician wanted to retest due to recent COVID vaccine). Had another PSA on 6/21. This time was .7. He was sent for PET scan this past Friday which came back negative. Urologist referred to in house radiation oncologist. Appointment was yesterday. I asked nurse before he came in if my husband has radiation now could he have it again down the road if there is recurrence. She said that would be a question for the doctor. When he finally came in the room, the first words from his mouth were "this is his best, last chance." Needless to say, my husband and I both were in complete shock.... I have since contacted Moffitt and we have an appointment Tuesday. Has anyone had a rising PSA so soon after surgery? If so, what type of additional treament did you have? While hearing cancer is terrifying, we did not think the outlook was terrible until our visit with the physician yesterday. Any insight would be greatly appreciated.

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?

I would like to update my treatment. Been on orogovyx for 78 days. Testosterone down fm 255 to 42. Have had 8 of 36 srt, psa down fm .28 to undetectable. Appears to b good signs. Comments please.