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