Post prostatectomy: What do rising PSA levels mean?

@jic811, I can see you remain concerned about your rising PSA since your last post last year. I'd ask the same questions as @james1951. Did your oncologist say why he is not concerned? At what threshold would he recommend further treatment? Have you had other diagnostic testing to rule out cancer recurrence?

Is it time to refer back to Mayo Clinic for a second opinion?

I also want to point out the great advice provided by fellow members @dpcarriere and @kujhawk1978 in this related discussion:

- Rising PSA's after treatment - an answer https://connect.mayoclinic.org/discussion/rising-psas-after-treatment-an-answer/

The bottom line:
Everyone is different. It's about the trend line. I encourage eveyone to click the link above.

Thank you Coleen, that was kind of you.

What I would like to point out is the fact that this group exists at all. I have learned so much here and am merely passing on what may help others make their lives a wee bit easier. I would like to see more involvement from others even if it seems insignificant. The more we know the better we shall all become. So please join in, if even just to say hi I'm here.

Thank you all for being here,
Dale

Hmmm, some thoughts:

Now over e years post prostatectomy, wondering what might make psa go from all 0 to 2.6…

You have a typo so hard to say not knowing how many years since his surgery. As a general rule of thumb you have your PSA checked every three months after surgery for the first year, every six months for years 2-5 and annually after that.

So, it would be helpful to know where he is in that time and space and what the results of his PSA tests have been. That would inform us of PSA doubling and velocity times, an important piece of clinical data that can be a part of any treatment decision.

The 2nd piece of data would be any clinical and health history - biopsy, surgery pathology report, and CV, metabolic, kidney, liver, diabetes...

Finally, has there been any imaging?

As I said, I would want to now the PSADT and PSAV, a general rule of thumb is >12 months, watch, 6-12 months, consider treating, < 6 months, treat now.

At his PSA, if he has not had imaging then most scans will locate the recurrence - C11 Choline, Aximum, PSMA PET/CTs. That is critical data in determining whether to treat and how.

If the recurrence is in the prostate bed and does not show any evidence of PLN involvement then you could do SRT to the prostate bed only. A challenge there is micro-metastatic disease PCa too small for the scans to see so you may consider adding short term ADT, s-18 months and extending the radiation treatment field to the PLNs.

If the scan show PLNs then the radiologist can build a treatment plan that includes all PLNs and boosts and wider treatment margins around the identified locations.

The PSADT and PSAV are important in determining how aggressive the PCA is and can guide your treatment decision, for example, if the PSADT were less than 3 months, you may want to consider triplet therapy, radiation, ADT and either a 2nd ADT or chemotherapy.

I am somewhat surprised by no imaging done given the increase from undetectable to 2.6. There are differing opinions about when to treat, some say when the PSA hits 4, others 10... I would not rely on PSA alone as a trigger to start treatment, I would want imaging too!

Kevin

I am confused about PSA readings. Many of you have readings of a specific number from 0.1 upwards. I am 5 years post treatment and all of my readings have been by the same lab and all have been the same,<.03, which I am told is the lowest the lab could read. I did have one reading from the VA lab and that was<.02. Is it possible to get readings of 0.00 or<0.01?

Hi,
No medical professional here, however, based on what you are stating and what I have learned, is it possible he is considering the rate of your doubling time as a consideration for 'wait and see'.? It appears (if I am reading your scale correctly) your DT is slow and perhaps they do not want to 'overtreat' unnessarily? It may be worth a second opinion however.
D

I ran across a paper, which is not exactly on point, but I think may be useful to some. I tried to include as an attachment, but it was slightly to large a file. The title is:
" Low Detectable PSA after Prostatectomy - watch or treat? " by Koulikov et al.

@swdg, allow me to add a link to the paper

- Low Detectable Prostate Specific Antigen after Radical Prostatectomy—Treat or Watch? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586061/

Did you have treatment after prostatectomy or choose to watch and wait?

Colleen - After RP In 5/16 my psa was < .01 for about a year. Then it was .01 and started slowly escalating. It was up to .11 about 16 months ago, but has come back down to .07. My oncologist agrees that treatment does not make sense yet. So no further treatment since the RP. Thanks for adding the link. - Steve

Interesting article, a little tough to digest before my second cup of coffee, but, if I'm reading this ;"American Society for Radiation Oncology)/AUA (American Urological Association) guidelines for adjuvant and salvage XRT after RP define BCR as detectable or increasing PSA that is 0.2 ng/ml or greater after RP with a second confirmatory level of 0.2 ng/ml or greater.15"

I wasn't even at BCR yet when we started the radiation....
I only got as high as .091 and there was no second confirmatory before they referred me to the RO. If this is still the current train of thought, I'm a little surprised the insurance co didn't balk at it...
As suggested though, I may have missed some other variable...:)