Rising PSA years after radical prostatectomy

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.

I had my prostate removed in 2015. For 7 plus years my PSA remained at < .01 then it started to head north. The first test came in at .01, then to .5 then to 1, then to 1.31 and finally to 1.61. The VA doctor tried to tell me early on that the rise in my PSA was perhaps an anomaly! The cancer was spreading and I was told that I have an aggressive recurrent prostate cancer. From late August through October I received 39 external beam radiation treatments and the Lupron shot. The side effects of the anti-hormone shot along with the radiation has left me sick. Now I’m on an every three month blood test for PSA and testosterone levels. If my levels increase together I have to decide if I take the anti-hormone shot the rest of my life or wait until cancer lands someplace and fight at that time? Decisions!

It sounds like if you received 39 radiation treatments that your health team determined that the biochemical recurrence (BCR) was isolated to just a few places in your body. If they found it in many places, usually radiation isn't a treatment option. Hopefully your current PSA tests are less than 0.1 and unfortunately "welcome" to the club of overcoming & managing the side effects of Lupron (ADT treatment). My health team indicates that my ADT treatment will last for 24 months, and presuming the efficacy is good and my numbers remain undetectable, I will stop the ADT and aim to resume normal activities (natural rise of testosterone, and all that comes with it!). Getting back to your situation, treatment options are a personal choice and no one knows how the velocity of a BCR. Other options that you need to consider and possibly share with all of us, are your age, overall health, co-morbidities. These factor into the quality of life equation. Overall, you are not alone, so keep reading and asking questions. Keep The Faith.

Hey Edmund 1971 thanks for the reply. My Urologist and Radiation Oncologist both believe that my recurrent cancer is in the prostate bed and surrounding lymph nodes. I’m only a month removed from the cessation of the radiation. My guts are all messed up, I go from constipation to diarrhea constantly. The majority of the time it’s diarrhea. My last shot of the Lupron was on June 30 and I and my Urologist have decided to stop the ADT right now and see how the PSA and Testosterone do. In the meantime as I mentioned earlier I will continue to have tests every three months.
I’m 70 years old, in great shape with no comorbidities. I had a heart attack in 2019 and had to have my Cardiologist clear me for the first Lupron shot.

Thanks again, I continue to fight this crap every day and refuse to stop

Hello Scotty,
I am 69 years old and had my “RALP” performed on 10/25/22.
My PSA has thankfully remained at < 0.014 since the day after my surgery through to this week.
I know that the possibility of BCR is something that every PC Patient needs to be aware of and realize might happen down the road at some point.
Unfortunately, once you have cancer you’re either in remission or you’re not for the rest of your life.
I hope I don’t have to deal with it but if I do, I will address all the related issues and facts at that time and proceed as I see fit along with my team of physicians and specialists.
So…..I can’t give you any experiential advice or suggestions other than to educate yourself as much as possible on the subject. More “Knowledge” can produce more power in almost any situation.
As you know, when it comes to PC, it’s a condition that one needs to monitor closely and consistently for the rest of their life.
As almost every patient is different to a degree in a number of areas, the “No Size Fits All” mantra is repeated!
I wish you the very best in your continuing journey that faces us all.
GODSPEED

Scottyrussell:
I had similar radiation to the whole prostate bed and pelvic lymph nodes together with 4 mos ADT (Orgovyx) Feb - June.
And I had very difficult radiation proctitis, possibly related to the balloon insertion that was necessary in my case.
Radiation side effects dissipated about 4 weeks after radiation completed, and additional ADT side effects 95% gone 4 mos after ending ADT.
Hope you are improving/recovering and continue to do so.

I had a radical prostatectomy in 2008 with negative margins. My PSA initially was undetectable but started to increase very slowly. By 2023, it was 0.2-the threshold for a recurrence. After much discussion and debate, I decided on hormones and 37 radiation treatments. One difference: instead of Lupron or other injected hormones, I took Orgovyx which is a once a day pill. I encourage men to ask about it because there are several advantages over the other hormones : no injection, faster decrease in testosterone , faster return of testosterone when you quit, fewer heart toxicities, and, unlike Lupron, etc., you can always stop taking it if the side effects are a problem. I experienced some occasional hot flashes but overall found it pretty benign. It can be expensive but I’m aware of no other disadvantages over Lupron, etc. It’s really worth asking about!

Dear Scottyrussell,
There are many relatively new FDA approved drugs available for treating recurrent PCa. According to the Johns Hopkins' website on Chemotherapy for Prostate Cancer, after starting the drug docetaxel, "many men experience improvements in disease-related symptoms, including pain, fatigue and loss of energy." I'm not a urologist or oncologist, but as a PCa survivor (8 years recurrence-free, post-prostatectomy), I have followed the progress in diagnosis, treatment and symptom management for many years. The good news is that much progress has been made in all these areas and it can be difficult for some PCa specialists to keep up. Good luck and seek more than one opinion on the best treatment plan, especially at a medical center of excellence in treating prostate cancer.