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Many years since radical prostectomy: PSA values rising

Posted by fag @fag, Jun 4 9:45am

I had radical prostectomy 25 years ago and controlled years of the psa values. in the last four years those values have increased from 1.1 to 5.2 in four years. Done PET test with nucleotide and found activity in the pelvic bed. The urologist+oncologist suggest ADT and IRMT for 2 years.I am 87 years old with ,as often usual, kidney problems and blood pressure medically controlled. I have read that the side effect of the ADT are often worse than those from radiation treatment.
Given my life expectation, should I simply do nothing?

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Jeff Marchi | @jeffmarc | Jun 4 10:34am

Ask to have nubeqa instead of ADT. It has almost no side effects and will keep your PSA low. I know a lot of elderly people that are on it and love it.
When I had eight weeks of IMRT radiation I had no side effects at all. Because you will have fewer sessions you may have some issues with peeing it can burn, but it goes away after a couple months. If that does happen, come back and ask, there’s a drug you can take.

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danchmo | @danchmo | Jun 4 1:38pm

I am 79 years old. I had a prostatectomy 13 years ago. Gleason score was 8. My PSA has been rising. Latest readings are: Jun 9, 2025 = .390, Dec 1, 2025 =.570, May 18, 2026 = .680 I had a PET Scan Jan 5, 2026 that did not show the location. Next PET Scan is scheduled for Jun 22, 2026. Not getting much info from Urologist.

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4 replies
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Jeff Marchi | @jeffmarc | Jun 4 9:01pm
In reply to @danchmo "I am 79 years old. I had a prostatectomy 13 years ago. Gleason score was 8...." + (show)
Profile picture for danchmo @danchmo

I am 79 years old. I had a prostatectomy 13 years ago. Gleason score was 8. My PSA has been rising. Latest readings are: Jun 9, 2025 = .390, Dec 1, 2025 =.570, May 18, 2026 = .680 I had a PET Scan Jan 5, 2026 that did not show the location. Next PET Scan is scheduled for Jun 22, 2026. Not getting much info from Urologist.

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They should be setting you up for salvage radiation. When they can’t find it, that is usually where it is located. Your urologist is not following the standard of care.

Here’s information from the America Society of clinical oncology that discusses what to do after your PSA rises following a prostatectomy

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

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3 replies
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diverjer | @diverjer | Jun 4 9:53pm

Sorry to hear that, doesn't this prostate cancer ever go away. After 25 years, I would have thought no way it would come back. I am learning a lot and seems this stuff can hide for a long time.
I certainly would do some checking on options at multiple locations.
Lots of folks on here have knowledge about things like this, not me, I am learning.

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1 reply
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heavyphil | @heavyphil | Jun 5 6:03am

It all depends on your general health. Well Controlled HBP or diabetes usually remains stable with ADT.
But I would opt for 6 months Orgovyx (fewer SE’s than Lupron) along with IMRT if you do choose to have treatment.
It’s the combo of ADT/radiation that causes the cancer to die; studies are finding that for localized recurrence, longer than 6 months is of little benefit and can actually be harmful.
Best,
Phil

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heavyphil | @heavyphil | Jun 5 6:28am
In reply to @jeffmarc "They should be setting you up for salvage radiation. When they can’t find it, that is..." + (show)
Profile picture for Jeff Marchi @jeffmarc

They should be setting you up for salvage radiation. When they can’t find it, that is usually where it is located. Your urologist is not following the standard of care.

Here’s information from the America Society of clinical oncology that discusses what to do after your PSA rises following a prostatectomy

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

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@jeffmarc I see you are up and posting - how did your procedure go? Feeling OK?
Phil

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1 reply
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danchmo | @danchmo | Jun 5 6:29am
In reply to @danchmo "I am 79 years old. I had a prostatectomy 13 years ago. Gleason score was 8...." + (show)
Profile picture for danchmo @danchmo

I am 79 years old. I had a prostatectomy 13 years ago. Gleason score was 8. My PSA has been rising. Latest readings are: Jun 9, 2025 = .390, Dec 1, 2025 =.570, May 18, 2026 = .680 I had a PET Scan Jan 5, 2026 that did not show the location. Next PET Scan is scheduled for Jun 22, 2026. Not getting much info from Urologist.

Jump to this post

thank you!

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Profile picture for danchmo
danchmo | @danchmo | Jun 5 6:36am
In reply to @jeffmarc "They should be setting you up for salvage radiation. When they can’t find it, that is..." + (show)
Profile picture for Jeff Marchi @jeffmarc

They should be setting you up for salvage radiation. When they can’t find it, that is usually where it is located. Your urologist is not following the standard of care.

Here’s information from the America Society of clinical oncology that discusses what to do after your PSA rises following a prostatectomy

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

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@jeffmarc
Thank You Jeff for responding and for the information!

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chippydoo | @chippydoo | Jun 5 7:12am
In reply to @jeffmarc "They should be setting you up for salvage radiation. When they can’t find it, that is..." + (show)
Profile picture for Jeff Marchi @jeffmarc

They should be setting you up for salvage radiation. When they can’t find it, that is usually where it is located. Your urologist is not following the standard of care.

Here’s information from the America Society of clinical oncology that discusses what to do after your PSA rises following a prostatectomy

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

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@jeffmarc Aren't their other scan types available if the PSMA doesn't find it?

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1 reply
Profile picture for fag
fag | @fag | Jun 5 8:25am

The PER test indicate activity both in the prostatic loge and in the linphonodes in the pelvic region . They provisionally indicate ADT for two years or only IMRT for time length to be decided. Should I avoid ADT altogether?

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