Rising PSA years after radical prostatectomy

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

Welcome, @zj69. Rising PSA is a common concern among members here. For that reason, I moved your questions to this existing discussion so you can read previous posts and connect with members easily:
- Rising PSA years after radical prostatectomy https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/

I agree with @web265 that interpreting your pathology results is out of the league of fellow prostate cancer survivors. I also agree with the tips he shared with you here: https://connect.mayoclinic.org/comment/772319/

You ask the questions on everyone's lips:
1. is it curable after reoccurring?
2. Life expectancy rate: How many years can you survive?

I hate to be the one to tell you that you'll never get direct answers to those questions. Oncologist rarely use the word "cure". Cancer goes into remission. You can live with it. These are more likely the responses you'll hear.
While some might give you a statistical response to your query about how many years, but that is a population-based answer. Your doctor may have a better guesstimate based on your diagnosis, personal health status and existence or absence of other conditions. But it is only that - a guesstimate.

You are in good hands at UHN in Toronto. What treatments, if any, are being recommended after surgery?

Good information. Have you had radical prostatectomy - postrate removed? I thought without a prostate the bench marck was 0.2 for salvage treatment.

Removed 2009 so 13 years ago yesterday. Now almost 80 years old. 5 years ago PSA slowing rising and went to .72 a year ago slowly over 5 years and Vanderbilt prostate oncologist said just check each 6 mo. Now to 1.02. Still says watch at my age. No symptoms and had scan and he says watch?