Rising PSA years after radical prostatectomy

Proton radiation is early 2010 at Loma Linda, an early leader in the utilization of proton radiation therapy. At that time, PSA was 6.7; biopsy indicated cancer on one lobe of the prostate gland. From 2010 until 2016, PSA zero/0; beginning 2017, PSA was noticed at .4. As October 2020, PSA at 2.47.

Question: Does the return of PSA levels positively indicate a return of prostate cancer? As most know, the rule of thumb is anything below PSA of 4 is normal.

At this juncture, I plan to wait alitle longer, then head up the road to Mayo Clinic in Jacksonville, Fl for a review of the options. For example, can another biopsy be done?

Any comments from first hand experience is appreciated.

Regarding your post: Based on what I am understanding you still have a prostate. And, therefore you will be producing PSA. My prostate is gone. The whole kit and caboodle. My doc made it real clear that if any PSA shows up in my lab work that means that there are still cancer cells present in the body that are producing the PSA.

In my case, my prostate was shot. My Gleason scores were as high as they could go. 10's all across the board. (That's bad). While doing the prostatectomy they found that the cancer spread to other parts of my body, They did all kinds of stuff to kill it, but they made it clear the cells could still be present, but dormant. They could be anywhere in my body but just not active. Or should I say, kind of asleep.

Well, once they attach to something that they can feed off, they start producing the PSA again. So in my case, the cancer was never gone, it was in remission. Which, is a blessing, right?

Once again, I ain't no doctor, but your case sounds completely different. So yes, I would say you should be asking an oncologist some questions.

Thanks for the comment. It appears that with radiation or surgery, if PSA begins to rise, then the potential for the onset of cancer is still apparent. I had a very low Gleason score and diagnosis was slow growing cancer on one lob of the prostate gland.

From reading all these years about this disease, there are few absolutes in terms of prostate cancer. My PSA went from zero in 2010 post proton radiation to currently 2.47 rising gradually beginning in 2015.

I hope to visit Mayo Clinic in Jacksonville, Florida sometime in the future to look at options. But, I suspect not much can be done. Currently in excellent health.

At 71, 2 and 1/2 years after my Radical Prostatectomy . No issues, until now PSA has been < .006.
Test last week 6 months after the last .006, showed a PSA .117 . Not thinking, I did ejaculate either the morning of or day before the test as well as an hour bike ride the day before. Don't know if that has impacts once prostate is removed. Would it be time for imaging tests already or wait and see the next test results in 3 or 6 months. Will be seeing urologist this week, but wondering what I might be asking or what to expect. thanks

PSMA PET scans have greater accuracy at higher PSA levels.
I think below .2 sensitivity is 20 - 30 %
That said, it is thought that recurrence is from PCa cells in the pelvic area and/or pelvic lymph nodes.
I had IMRT radiation and 4 mos of ADT due to PSA .19 post prostatectomy.
Obviously, you need to consult with a Urologist and/or a Radiation Oncologist/Medical Oncologist.
Rising PSA is trended over 2, 3 or 4 tests, so first step probably is repeat PSA.
If rising, perhaps PSMA PET scan to rule out discernable distant metastases.
And then radiation and ADT.
But I am getting way ahead.
Prostate Cancer Foundation webinar on PSMA PET scan sensitivity an utilization at:
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March 14 2023
Good luck. Hope it's an anomaly and next test is back in line.

Ejaculation and bike riding will increase one's PSA reading. It is recommended that you avoid both prior to your PSA test. Google and you will find out how many days before to avoid those two activities. Make sure the PSA test is done at the same lab. I would not consider any imaging test yet but would recommend that you have another PSA test, either in 3 months or currently if that will give you peace of mind.

PSMA Pet scan would probably be something they would want to do

I am 81yo and had a radial prostatectomy in September 2018. I have always had low PSA so when mine went from .9 to 2.1 over a 1 year period I wasn't alarmed. During a physical the doctor did a rectal exam and didn't like the feel of my prostate so he ordered a biopsy. It came back with Gleason score 10 and after much deliberation I decided on removal over radiation. They also removed 15 lymph nodes and one tested positive. I have since had about 6-7 PSA blood tests and all show less than .1 which they call undetectable which is the smallest that my hospital lab gives. My point is that PSA has a wide range of variability. I have a friend that has tested PSA in the teens and they are just "watching" him not concerned about cancer.

Have you had a scan? MRI? PSMA PET/CT?

I had a CT scan with contrast before the surgery and it found no apparent metatheses. I can't have a MRI because I have a large rod in one leg.