Rising PSA years after radical prostatectomy

I am six months post RP and my PSA jumped from "undetectable" 3 months ago to 0.51 today. Waiting to speak with my urologist. I assume scans and radiation are in my future but I'm seeking advice and suggestions from others who have been here before me.

I would think scans, SRT radiation and they will likely suggest ADT therapy as well. My jump in PSA percentage wise was very similar to yours.

I wish I could find the chart but I'm not having any luck. Someone posted a chart in here that showed a correlation between PSA level and positive results from a PSMA scan (meaning finding cancer). I had the scan but none was found. (my PSA level was only .091 at the time, but rising quickly) Maybe this will trigger a repost 🙂

I'll tell you that I was dreading getting this treatment, but, it really went by rather quickly and I was lucky to not have side effects that were too bad. If this is the route you take, hopefully you'll have a similar experience.

If I may, how do you define undetectable when taking the ultra-sensitive PSA Test?

Thank you web265 for your response. I appreciate you sharing your salvage radiation experience. I suspect I will follow a similar path and hope the side effects are not too bad. What is your PSA now? As for my undetectable PSA, all I can say is that it was <0.01.

Thanks for the clarification "undetectable" seems to mean somewhat different things to different folks i.e. drs, govt, labs etc.

My PSA went from .091 at the start of radiation and ADT to .014 one week after end of radiation treatments. They usually wait three mos for that test at my RO's office but I needed it for a different unconnected physical exam.

I had a radical prostatectomy 1 year ago. At 6 months post surgery my PSA was <0.04. Today (same lab) the result is 0.04. I realize this is still not a cause for concern, but does it represent a true, if minor, increase? What is the margin of error in the test itself?

I would suggest the answer to that is no. There are so many little things that can effect your PSA level that I wouldn't think that less than .009 max of a change is significant. What would be more important is to see if there is a significant trend come the next one. Even then if it's that small of an increase again, I still wouldn't be too concerned.

Its a minor change Yet ask oncologist if you should be on Zolodex Testosterone is the fertilizer of PC After 5 years since radiation cancer metastases to my L2 lumber which I had nuked a year ago with intense rad

Microscopic stuff floats around to kill off us old males Im 78 feel great but PSA 1.2 for years now 4.22

Hi - I am not a doctor. My situation has some similarities to yours. My PSA has gone up and down over the last 4 years or so after a RALP. You may want to check this out: https://prostatecancerinfolink.net/2015/01/14/low-detectable-psa-after-prostatectomy-watch-or-treat/

My most recent PSA was .07. It had been rising to .11, then it has been coming down since then. I have decided that if it does start rising and does so steadily, I will probably wait until it is .5 or so and then get a PSMA or similar scan to see if anything is found.

Best Regards

Hi
I underwent a Robotic-assisted Radical Prostatectomy on 15-Feb-2022 at UHN Canada. Surgical pathology on 15-Feb-2022 revealed adenocarcinoma, Gleason: 8 (3 + 5), and negative surgical margin involvement status. The disease was pathologically staged as T3a N1.

PSA RESULT
- PSA on 01-Apr-2022 (Total PSA is 0.017 ug/L).
- PSA on 12-Oct-2022 (Total PSA is 0.075 ug/L).

My Pathology report after surgery shows as under. My PSMA -PET test did not detect the Lymph node before surgery.

DIAGNOSIS
1. Soft-Tissue: periprostatic tissue: Mature adipose tissue, no lymph nodes identified. Negative for malignancy

2. Right external iliac artery node: Three reactive lymph nodes, negative for malignancy

3. Right pelvic lymph node: Four reactive lymph nodes, negative for malignancy

4. Left pelvic lymph node: Metastatic adenocarcinoma (diam < 1 mm) in one of six lymph nodes.

5. Prostate and seminal vesicles, weight 28 grams:
- Predominantly right posterior peripheral zone localization of adenocarcinoma, Gleason score 8 (3 + 5) with a high-grade component, comprising 60% of the carcinoma
- Positive for intraductal carcinoma
- Positive for (focal) extraprostatic extension, negative for bladder neck invasion or seminal vesical invasion (pT3a)
- Surgical margins negative for malignancy
- About 9% of the prostate volume involved by carcinoma

COMMENT
Immunostaining performed to exclude neuroendocrine carcinoma component: Both chromogranin A and synaptophysin are negative, while the androgen receptor is intense nuclear positive. The basal cell staining (HMWCK) highlights the intraductal carcinoma
component.

SYNOPTIC DATA

Procedure: Radical prostatectomy:
Prostate Size
Prostate Weight (g): 28 g
TUMOR
Histologic Type: Acinar adenocarcinoma
Histologic Grade
Grade Group and Gleason Score: Grade Group 4 (Gleason Score 3 + 5 = 8)
Tertiary Pattern 5 (less than 5%) in Overall Gleason Score 7:
Present
Percentage of Pattern 4: 40 %
Percentage of Pattern 5: 20 %
Intraductal Carcinoma (IDC): Present
Cribriform Pattern: Present
Tumor Quantitation: Estimated percentage of prostate involved by tumor: 9 %
Extraprostatic Extension (EPE): Present, focal
Location of Extraprostatic Extension: Right posterior
Urinary Bladder Neck Invasion: Not identified
Seminal Vesicle Invasion: Not identified
Treatment Effect: No known presurgical therapy
Lymphovascular Invasion: Not Identified
Perineural Invasion: Present:
MARGINS
Margins: Uninvolved by invasive carcinoma
LYMPH NODES
Regional Lymph Nodes:
The number of Lymph Nodes Involved:
Number of Lymph Nodes Involved: 1
Size of Largest Metastatic Deposit (Centimeters):
0.1 cm
Number of Lymph Nodes Examined: 13
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
Primary Tumor (pT): pT3a
Regional Lymph Nodes (pN): pN1
ADDITIONAL FINDINGS
Additional Findings: None identified
SPECIAL STUDIES
Ancillary Studies: NGS prostate

Please can you tell me about the following?

1. is it curable after reoccurring?
2. Life expectancy rate: How many years can you survive?

Thanks

This is out of my league at the level of detail in this report, but, after my RP, my PSA went up to .091 from .039 and we started salvage radiation therapy. My path report was similar to yours but no detected invasion in lymph nodes. (Right pelvic was removed to testing during the RP as the cancer was mostly on the right side of the prostate)

Before starting SRT, I point blank asked the radiation oncologist, who generally likes to answer questions with a statistic, if this treatment was considered "curative"? His answer was "absolutely." The quote regarding the PSA from him was that rate of doubling is not as much of an indicator in these very low number levels.

There are those here, and at this point I'm inclined to agree with them at this point, who might suggest it may not be time to do anything till you get another PSA test, maybe do it in three months if it makes you feel better. There are reportedly a lot of things that can have an effect on PSA, particularly in those low number realms.

My surgeon advised aggressive treatment as that is his style and I did the SRT. I had very minor side effects which have ended (except for the orgovyx occasional hot flash (or power surge as my wife calls it ).

Next question to the radiation guy was what if this doesn't work? he gave me a sort of "we'll cross that bridge.." answer but added that I'd most likely pass with PC as opposed to from it.

Sorry to hear that you're going through this and best of luck to you!