2 years post prostatectomy with psa rising

Sorry to hear that your PSA is rising. My PSA was .19 90 days post op.
Answer is both simple and complex
PCF.org and others have patient webinars on post-op rising PSA.
SPORRT trial supports radiation treatment to the prostate region and pelvic lymph nodes together with a course of ADT for biochemical recurrence (BCR). BCR is roughly defined as PSA rising to .2 - .4/.5 range
I was treated with IMRT radiation and a short course of ADT and have had undetectable PSA readings for about 2 yrs.
That is a brief summary of one man's experience.
A number of factors will influence the decisions and timing of treatment. And BCR while undesirable, is not uncommon and treatable.
Best wishes.

I'm sorry for your news. It may just mean that there was a little cancer outside your prostate that was originally too small for imaging to detect: a prostatectomy removes 100% of the cancer in your prostate but 0% of the cancer near your prostate, and sometimes medical teams misrepresent (or patients misunderstand) the limits on a prostatectomy's effectiveness.

Fortunately, if there's just a little local spread, radiation therapy can be very effective at cleaning it up. Unlike surgery, radiation doesn't have a hard stop at any organ's walls, so it can zap stray cancer cells not only where your prostate was, but also in the parts of your bladder, urethrea, colon, etc right adjacent to that.

The down side is that you might get a little mild irritation in those areas: usually it goes away after a few months, but for a small minority of us, it's permanent (no regrets, though: if it irritated my bladder and rectum, then it likely got any stray cancer cells there in the process).

First step is to get scans to find out where the recurrence is —> MRI & PSMA PET scans. Then consider treatments.

If you can find it, you can fight it!!

In part, that depend on the clinical data...

Gleason Score
Grade Group
Pathology Report
PSADT
PSAV
Genomic Testing
Decipher Testing
Age
Co-Morbidities

There are guidelines based on one's clinical data, the NCCN and AUA. They are the science and guide discussions with the medical team. Often referred to as the "standard of care." Still, they may lag behind data emerging from clinical trials and are population based so may not fit neatly one's own clinical data.

The clinical data is crucial as it can determine one's risk and thus the treatment strategy and decision, as an example, PSADT >12 months is a consideration in continuing to actively monitor, no treatment considered necessary at this point. Less than three months, well, may need to decide now.

Imaging is crucial with two caveats:
At what PSA will you image? Too low and you may see nothing. What's the risk of waiting for a higher PSA to increase the statistically locate recurrence? For my medical team and I that is .5-1.0, roughly doubling the chance of successful imaging below that.
Will imaging inform the treatment decision? If one has a "fear" of radiation and prefers just to do systemic therapy, well then, may not be a need to image!

So, once you gather all the clinical data, red and understand the guidelines, poke around sites such as PCRI, PCF and others, are comfortable with terms and definitions, have a discussion with one's medical team.

There is some data that says MDT by itself can push back the need for systemic therapy in low volume PCa.

There is doublet or even triplet therapy, ADT + ARI + chemotherapy though the latter usually reserved for high volume and "fit" individuals. Certainly radiation can be a part of doublet or triplet therapy, has been in both mine.

If treatment is necessary and you decide on what then more choices may need to be made, which ADT agent, which ARI...while they all have generally the same outcomes, they are not all equal in the side effects and recovery.

Another decision will be the duration of treatment.

Yet another decision will be what is the criteria for coming off treatment? I believe in the EMBARK trial those who achieved a treatment response of undetectable in the first seven months were allowed to come off treatment and actively monitor. In my case, a PSA nadir of undetectable on the first three to six months on treatment T has been a key criteria on if and when to come off treatment.

There is not a single right decision the science of medicine and members of this forum can point to in making your decision. There are as I say a plethora of choices, that in itself can lead to "paralysis by analysis."

There are plenty of good decisions though. As you continue collecting clinical data and discussions with his medical team, certainly share with this forum who can provide their thoughts.

Kevin

I know that everyone's situation is different, but here's my experience with prostate cancer, robotic removal, and rising PSA 10 years after prostatectomy. I was diagnosed in 2007 with a Gleason score of 6=3+3. That's slightly above mid-range on aggressiveness. I was given a number of treatment options at that time and chose Robotic surgical removal. After surgery I was told that the surgeon was unsure whether the margins were completely clear and that a few cells may have penetrated the prostate. After surgery my PSA dropped below 0.05 where it stayed for many years and was often reported as zero or below testing accuracy. It stayed there for about 10 years and then began slowly rising. In 2018 it had risen to 0.13 and a chart showed that the rate of rise was increasing. My urologist recommended not doing anything until the PSA got significantly higher, but I was unwilling to wait. Since no tumor was visible, he referred me to a radiation oncologist for consultation. The oncologist recommended 39 low intensity radiation sessions focusing on the area where the prostate had been removed. He mentioned some possible side effects at the time, but I was intent on getting rid of the cancer, so we went ahead with the radiation. The radiation dropped my PSA to below .05 and it fluctuates in a range of 0.01 to 0.03 today, seven years after the radiation. After healing there were no significant side effects for about six years. About a year ago I started periodically having blood clots and some occasional blood in my urine. My urologist did a cystoscope of my bladder just to check for any signs of cancer in the bladder and said it was all clear. I haven't been given any clear explanation for the occasional minor bleeding and blood clots other than that the area where the prostate was removed likely had small weak blood vessels that had grown back. It's likely that straining or heavy lifting may be causing the bleeds. The good news is that it's now 18 years after my initial diagnosis, I'm 80 years old, and in relatively good health. After the initial diagnosis I didn't think I would live another 5 years. I hope this helps. Good luck with your decisions.