Biochemical recurrence, On / Off treatment with Orgovyx only

Those PSA numbers seem quite high given that your prostate was removed. Generally, BCR after RP is defined as 0.2 and treatment is usually begun at that point.

My main question is that if the PSMA PET scan shows a recurrence at a single site, why would radiation not be indicated? If it were all over the place that would be a different story, but in this case, I would think radiation would be indicated, perhaps combined with ADT.

Have you been on ADT? Most (including me) thought it was the most difficult part of radiation + short (<6 months) ADT. You would probably have a better quality of life if you did a few radiation treatments to the prostate bed.

Hi,
Radiation is a definite possibility, if you do go that route make sure they install the protective gel to protect your rectum. Ablation is another option you could look into. The side effects can occur with radiation or ablation, there are no guarantee’s. Make sure you go to a center of excellent for whatever you and your doctor team select based on your circumstances. Best facility+best doctors=the best results. The better facilities and experienced doctors should lesson your chance of long term side effects.

Dave 3+4

If he has his prostate removed, I didn't think there was anything they could put in to protect rectum as they need prostate to hold it in place. Also, that doesn't sound right, PSA of .45 and now .99?? They should have been doing something before it even got to .45?
But I am not a doctor.

After a prostatectomy, you’re supposed to get salvage radiation when your PSA hits .2. That’s what happened to me. 3 1/2 years after my prostatectomy, my PSA started rising when it put .2 they gave me a looper shot and two months Later I had 40 sessions of salvage radiation.

You have waited longer than you should have. You need a PSMA PET scan to see if the cancer has spread somewhere outside the prostate. Ask your doctor about this they should be already planning on this.

Here is with the American Society of clinical oncology has to say about getting Treated when your PSA goes up after a prostatectomy. This is something else you need to discuss with your doctor. Why have plans not already been set.

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/

@jeffmarc

Just a note - he had PSMA.

He now has BCR with PSMA confirmed location in prostate bed.

Just curious, was 0.45 your lowest PSA after your prostatectomy?

@mjp0512
My mistake was I had my robotic prostatectomy done by Dr. Vipal Patel and thinking he was God I never thought I would have to worry about dealing with this again, WRONG!
After prostatectomy PSA was <0.1 on 2/28/2020, <0.1 on 10/2/2020, 0.05 11/2/2021 (Hello! That was the warning light!) then 0.45 on 1/24/2025, then most recent blood work it came back at 0.99 on 4/24/2026.

@biggalew May I ask why you weren't tested between Nov 2021 and Jan 2025? That's more than 3 years, when you should have been tested every 6 months at a minimum. You have a doubling time of around one year which is pretty fast.

You need to talk to a radiation oncologist ASAP.

@optimistic
Had blood work done else where at that time, you got me digging around and I found I had 2 other tests, can't find anything for 2022 but I had a .2 on 7/20/2023, then on 1/24/24 it was another .2
Optimistic, what your input on just going with getting onboard with a medical oncologist and doing the on/ off treatment with Orgovyx?