your question to the forum is?

PSA can vary for a number of reasons....

What you want to consider is a continuous upward trends, three or more readings spaced somewhere between 2-4 months apart.

As much as you can try to keep the conditions the same, lab, time, what you do prior....

Have decision criteria, how many labs, how far apart, at what PSA will we image...

What is the decision criteria to start treatment - number of PSA increases, imaging, PSADT...and what will that treatment be based on the clinical data, your preference for balancing quality and quantity of life, any co-morbidities such as cardiovascular which may influence choice of treatment..

Kevin

Biochemical Recurrence (BCR) after prostatectomy is not uncommon and often defined as PSA greater than .2 (after recheck).
Treatment "sweet spot" is .2 - .4/.5
Absent imaging identification of cancer elsewhere, belief is that cancer cells remain in and around prostate bed and/or pelvic lymph nodes.

See SPPORT trial.

I had immediate postop BCR at .19 (retested .18)
Salvage treatment (tx) at Johns Hopkins: Whole pelvic and pelvic lymph node radiation and 4 mos ADT completed 6 mos ago. First post salvage tx PSA undetectable at < .02. Praying for undetectable to continue of course.
Clearly, your Radiation Oncologist/Medical Oncologist will guide you.
Best wishes.

You should follow the advice of kulihawk1978 and michaelcharles. To understand the trend; what were your PSA's prior to the .22. Make sure you use the same lab and avoid bike riding and sex for a few days before the PSA test. It would appear that you are looking at BCR (biochemical recurrence) and a consult with your radiation oncologist is in order. You should start researching BCR after surgery to better understand the next step in your journey.

Take a look at a PCF webinar dated January 17. It's title is Rising PSA. A surgeon and oncologist discuss rises in numbers and their significance. As your title says Don't panic as your number is still not definitive of BCR but it should be watched more closely according to the seminar. You're getting another PSA test in a month so your care team has already started that it appears. Hopefully it drops again in the next test.

Thanks for the inputs. I had surgery two years ago. My PSA has been tested every three months. So far it’s been undetectable. However, I know I need to continue with testing and monitoring. In my case, cancer was found in a lymph node after surgery. (Ugh) I chose quality of life, not quantity. (No radiation or shots.) Starting next month, I’ll get my PSA tested every six months. I’m praying it remains undetectable.
Thanks again for everyone’s feedback! Jerry

Echo all the above. The current SoC is you can or should do a PSMA Pet Scan. That should find the cancer cells if there are any. At that level it is very treatable, with focal and or systemic therapy.
Dont mind me. I am just another layman trying make some sense of the whole thing.

Dr. was concerned with a .22??

Hi all at my prostate out in 2014. got checks every six month till 2019 the surgery did not detect that my PSA level had gone up to 0.05. my surgeon recommended if it went above 0.01 action needs to be taken. The doctor surgery did not tell me the surgery didn’t bother, checking my records so now the cancer has spread to my lymph nodes stage four been through chemo last four months waiting for test in January to see where I am from there my PSA level went down to 0.01 after chemo will have to see what it is in January. Fingers crossed. Hope this is useful for anybody’s predicament.

@dontpanic67, I moved your question about fluctuating (and slowly rising) PSA 3 years after prostatectomy to this related discussion:

- Rising PSA years after radical prostatectomy https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/

Interestingly @knoyes01 @jackiepie @olanordman had similar experiences 3 or so years after surgery. Click the link above to see the helpful answers from many members in addition to the replies you've already received.

Bottom line:
PSA is a helpful tool. The trendline is what your cancer team will monitor. If an anomoly is suspected, further testing will be ordered and further treatment may be considered in conjuction with your health status and personal preferences.