Post prostatectomy: What do rising PSA levels mean?

Did you recently have RP? If so, did they find microscopic levels of PCa in the removed lymph nodes or anywhere else perhaps?

My RP was just over a year ago, Sept 2, 21.
I'm going to quote the pathology report

Perineural invasion is identified
Lymphovascular invasion is identified
Surgical margins are free from carcinoma.

I had also had the actual right pelvic lymph node removed, it was "negative for matastatic carcinoma"

It sounds like your doctor is being very cautious because of the first 2 findings on your report maybe. Is he putting you on hormone therapy also?

Post radical our urologist referred to radiation oncologist at 0.2 and before first appointment hit 0.331 day of first Eligard injection, starting 40 Radiation treatments mapping appointment 2.5months..
PSA 5.3 at diagnosis
at biopsy Gleason 9
radical prostatectomy biopsy edges clean seminal vessel clean lymph’s
clean
8weeks post RP PSA less than 0.1
12weeks post 0.2
16weeks 0.3

Yes. Orgovix

Try a search for PSA LEVELS AFTER PROSTATECTOMY May 2022.
I don't know if it will help, Good Luck
There are a lot of therapies out there if something turns out crappy
I have PCa also and opted for radiation. PSAis good so far. Prognosis is iffy w lymph nodes involved and other signs of metastasis.
Such is life.
Spryguy

I am confused by the post-RP psa results I've gotten. My readings were as follows since my RP surgery in 2015.
From 2015 through 2/21: < 0.1
8/21: 0.00 (different lab)
6 weeks ago: 0.04 (a 3rd lab)
today: < 0.04 (same lab as 6 weeks ago).

I don't know how to make sense of this. Since the last 2 tests were sent to the same lab, does the change from 0.04 to < 0.04 indicate that the psa actually went down? Or is it likely that the 0.04 from 6 weeks ago was actually < 0.04, and that 0.04 is the lowest reading that lab can detect? Does the 0.04 from 6 weeks ago indicate that the psa rose from the 8/21 reading?

The good news seems to be it's remaining pretty low. I had a couple confusing readings from the same lab when I started but it was because they were looking a two different sensitivities.

My first two looked like this...
10/22/21 PSA Result of <0.1
01/26/22 PSA Result of 0.039
They could literally be equal.

I'm a little surprised your team was content with that less sensitive test after RP till '21, makes spotting a trend a little tougher in the lower numbers.

My next result was 04/26/22 PSA Result of 0.091, we wouldn't have spotted the trend without that sensitive test. Water under the bridge for you thankfully at this point.

Equipment types and sensitivity may be what's happening between lab 1, 2 and 3. I would ask the doctor on the last two at lab three, if he doesn't give you a definitive answer, I'd try to get one from the lab.

I've had to check and make sure that the orders are for "ultra sensitive" PSA tests and go to the same lab so that they are apples to apples.

Either way the differences would be pretty minimal for the last two. Maybe it's something like
0.04 and 0.039 but their equipment doesn't get that specific.

Your results from 2015 through 2/21 indicate you and your medical team were using a standard PSA test that only detected to a single decimal. So, <.1 meant it was "undetectable" since it could not measure below a single decimal point.

Now you appear to be be using an Ultrasensitive PSA test which can measure to two decimal points...

A couple things to think about. If you were still using the standard test your lab result's would say <.1 and you would smile, set your next appointment and enjoy life.

With your USPSA test now comes "worrying" about every change in your results. As you can see from my attached clinical history, once my medical team and I switched to USPSA my results have been up an down.

With the standard PSA tests there are pretty agree upon definitions of BCR, a PSA of .2 (assuming you had surgery) with a subsequent PSA of .2 or higher usually 90 days later. There is also a wide range of discussion abut whether or not you can use USPSA in calculating PSADT and PSAV at such low levels.

Not so much agreement with the USPSA...What you and your medical team have to decide is what do you do with the results of an USPSA given the variability? What in your minds will constitute an contiguous upward trend - how many USPSA tests, how far apart...? What are the decision points, at what PSA, then to image, What PSA constitutes a decision to treat, 2, 4, 10...Some of that may be based on your decision on when to image, below .5 and current FDA scans have roughly a 30% chance of locating PCA, around .5-1 it climbs to around 60% and of course after that, keeps going up. Imaging can be a powerful decision tool in your treatment plan as long as you and your medical team believe the results may change your treatment plan. I believe it does, particularly if radiation is involved as then your radiologist can build a plan that includes boosts and wider margins around the identified sites.

With your PSA results, I would just continue to actively monitor,2, 4, or 6 months and based on your decision points about the results, act when you need to.

Kevin

My friend ( Mentor), there is a so called standard of care. I did not need this info but I am sure I could answer since you said nobody can. Yes, I am a medical professional, not doctor and not practicing. My advice: whenever you have doubts, go get a second opinion. Please.....