Does Cancer Creep Back After Prostatectomy?

Yes, it happens, even many years later, and I am one example of that.

RARP in 2015. Pathology showed Gleason 3+4 with one positive margin. My Prolaris score also projected a 53% chance of a BCR at ten years.

I went ten years, getting regular PSA tests and DREs. PSA stayed below detection (< 0.1), and like you, I never thought much about it or fretted over it. In 2024, my urologist detected a small, palpable nodule in my prostate bed during a DRE, but my PSA was still undetectable. No action at that point.

In June 2025, my PSA rose to 0.11. PSMA PET and pelvic MRI scans confirmed that the nodule was cancerous, but there was no evidence of spread beyond that nodule.

In fall 2025, I underwent salvage radiation therapy (38 sessions of IMRT). My PSA at the start of radiation (ultra sensitive test) was 0.094. Effectively no change in the three months since June.

So far, so good. No lingering side effects from the RT. My first post-RT PSA test came back at 0.086 (again, ultra sensitive test). Likely that my PSA will continue to drop as the cancer cells die off (the radiation damages their DNA, so they die when the attempt to divide).

The odds of a recurrence after 3-5 years post-RARP go down significantly, but there are guys that have recurrences 20 years later. Also, the longer the time to relapse, the more likely the cancer is slow growing.

The best thing you can do for yourself is to keep up with your PSA tests…forever.

I made the comment once that I hoped I was cured. I was reminded that cure is probably not a word to ever use with PC. Maybe remission. I have been undetectable for 6 yrs. I just moved to every 6 months PSA test. I would say more information would be needed by the experts to say what your chances might be. As Melvin pointed out he had one small positive margin. My post op confirmed G6 one small cancer lesion with clean margins and nothing in the lymph nodes. I will am still going to call it remission.

I know people with Gleason nine that had it return after 30 years following a prostatectomy. Some have it return after 10 or 20 years. One reason is, Even before the cancer is detected, dormant cells proliferate through the body. Some stressful event occurs they can re-awaken and become active cancer.

Here’s an article about it
https://www.dropbox.com/scl/fi/8wyq61jnnxl9g9cbmek5g/Dormant-cancer-cell-details.html

It can happen after BOTH, radiation therapy (20 t0 40% incidence ), and after prostatectomy with exactly the same chance.

The lower Gleason at the start of a treatment the better. Also, not having cribriform glands or IDC in pathology report highly lowers a chance of BCR or at least it prolongs time to BCR significantly (at least in theory).

Unfortunately if you go through hundreds of post here , you will wind people with gleason 7 that have BCR soon and gleason 8 or 9 that did not have it for decades so every single case is case for itself and nobody knows when and IF BCR will happen.

Yes, it happens. You can consult a number of different nomograms to calculate your risk as a function of your pathology. I had a 3+4 with a moderate cancer burden, clean margins, no adverse features and am undetectable at 9 months post RARP. My lifetime recurrence risk is probably around 15-20% (hopefully on the lower side given my low Decipher).

Neither RALP nor radiation are perfect processes. PCa has strange behavioral patterns. Some see the surgeon's knife or the physicist's radiation and go dormant...forever. Some come back in the prostate bed, the so called recurrence many years later. Other recurrences involve distant mets. Gleason and Decipher and treatment are the gauges we use to assess the potential for recurrence. I think these are inadequate to be totally accurate. I have seen men roar out of the gate 45 yo with Gleason 9 and have to fight the rest of their lives with recurrences. Another 45/9 man can be treated with no recurrences and live to be a grandfather.

"When metastases happen after a biochemical recurrence, they happen 7 to 8 years later, on average". https://www.mayoclinic.org/diseases-conditions/prostate-cancer-recurrence/survival-rates/gnc-20592196

"For patients with localized prostate cancer, remission rates after surgery or radiation exceed 90% at 10 years (Hamdy et al., 2023)".
https://oncodaily.com/oncolibrary/prostate-cancer-remission-rate
All statistics like these are based on years old information, obviously. New tests and treatments arrive all the time....

turns out it is somewhat common (from Prostate cancer and prostatic diseases)
" Nearly one-third of patients with prostate cancer (PCa) experience biochemical recurrence (BCR) after primary definitive treatment. BCR increases the risk of distant metastasis and mortality in patients with prognostically unfavorable features. These patients are best managed with a tailored treatment strategy incorporating risk stratification using clinicopathological factors, next-generation imaging, and genomic testing"
https://pubmed.ncbi.nlm.nih.gov/37679602/
I had RARP Jan 25 now have recurrence