Post prostatectomy: What do rising PSA levels mean?

Hi @jic811, welcome. Has your local oncologist suggested that further diagnostic testing is necessary at this point?

Thanks. Appt with oncologist at Vanderbilt tomorrow.

That’s great. I’ll be interested to hear what you learn tomorrow.

My prostectomy was 17 years ago. My psa level was undetectable until my recent test. It is now elevated.
Kenw

Hi @kenw and welcome to Mayo Clinic Connect. I am sorry for your rising PSA levels.
Can you share more about your story with us? What did your MD say about your elevation?

Dr. Said that 0.56 psa was a cause for concern and recommended I see a urologist.
Kenw

That's a starting point...17 years post RP is a good run.

So much has changed since then, heck, so much has changed since I was diagnosed in 2014...!

While you're waiting to see a urologist, may be time to catch up. Some start8ing points:

The NCCN Guidelines:

Early stage - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=49

Advanced Stage - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=50

The Prostate Cancer Foundation - https://www.pcf.org/guide/prostate-cancer-patient-guide/

Inform yourself on current FDA approved imaging, may be useful in your decision making process to locate any recurence.

There are four you may want to consider reading about, much has improved since the days of CT and MRI that I had in 2014.

C11 Choline
Aximun - https://www.petimagingflorida.com/pet-imaging-is-proud-to-offer-axumin-pet-scans/
PSMA 68 Gallium - https://www.pcf.org/blog/breaking-news-fda-approves-a-highly-sensitive-prostate-cancer-imaging-agent/
PSMA PET imaging agent 18F-DCFPyL - https://www.urologytimes.com/view/fda-approves-psma-pet-imaging-agent-18f-dcfpyl-for-prostate-cancer.

The PSMA ones are generally more sensitive at lower PSA, with a PSA of .5 -1 you could image and perhaps locate any recurrence.

You'll want to gather more clinical data - more PSA tests to gauges doubling and velocity times.

Informed by clinical data through imaging and PSA tests, combined with age, health and life expectancy, you can then make an informed decision about whether to treat, when and with what.

The imaging may provide information on where the recurrence is - prostate bed, lymph nodes, bones, organs...
The PSA tests may provide information on PSAT and PSAV, indicating aggressiveness.

If your decision is to treat, you'll have a wide set of choices that can range from mono therapy to combined regimens and can be short term, six months to several years or more.

Kevin

Hello, I had a radical prostatectomy July, 2013. I've had yearly psa test done and results have been <.1, however I just one completed today and for the first time received a result of .2, I'm 61 years old. I thought I had gotten past this since 7 years has passed, then upon researching after this result, I see 10 years is the benchmark. Kinda worried, sent my results to Alan Partin, my surgeon, but he's gone for the weekend. I read somewhere .2 is the benchmark for recurrence. Bummer.

I had radical prostatectomy July 2013 at 53 years old. Test yearly always came back <.1, today, I received result of .2 and my surgeon Alan Partin is gone for the weekend. Seems like .2 is the threshold for recurrence. I thought I was pretty safe after 7 years of <.1. 🙁 I'm 61 yo now and thought I was out of the woods… How concerned should I be and it it treatable?

No reason to hit the panic button.

You may have BCR with .2, another PSA test with a .3 or higher.

If so, you'd have done decisions to make, treat, when, with what?

Image or not? The newer scans can detect reasonably well at around .5. If so, that could inform your treatment decision.

If the clinical data supports treatment you'll have choices. A combined therapy involving radiation and ADT may be a choice, 6 months some studies say, 18 others. Radiation may include prostate bed a pelvic lymph nodes.

You may not treat too if the clinical data such as PSA doubling and velocity times which indicates aggressiveness. If PSADT is greater than 12 months you may just continue to monitor and treat later if needed.

There are other options than ADT too.

Do your homework, inform yourself, discuss with your medical team. You will have time to make a decision.