Does Cancer Creep Back After Prostatectomy?

I had a Prostatectomy in 2006. Mine returned in 2013 . Had 39 radiation treatments. Went undetectable. Recurring again in 2015. Make SURE you are vigilant about your PSA tests !

@jeffmarc I think that’s because not everyone gets tested. And they go many years back to have enough data points, to when such test may not yet have existed.

@melvinw
Radical prostatectomy in 2006. PSA .03 for 20 years and recent test is .3. A little nervous about the increase. I will retest in a few months.

@ahanahan I know your anxiety all too well. I was pretty surprised when my PSA became detectable after ten years. If your rise is a recurrence, at least the 20 years is in your favor. Keep on top of it! Sounds like a PSMA PET scan might be in your future.

@ahanahan
You probably should be getting monthly tests now. It is recommended that you get salvage radiation at .2. Your PSA has risen a lot. You need to find out how quickly it’s doubling.

Here are the recommendations for what you should do from the American Society of clinical Oncology.

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/

@melvinw
Yes and thanks.

My neighbor was 12 years clear and it came back. He is not on ADT. Ya can't count of this disease ever being gone for good. I focus on one day at a time and try to wring the most out of everyday while keeping expectations in check.

Thanks for sharing. It seems counter intuitive that the prostate can be removed with no negative indicators yet get later recurrence. Apparently the adenoid cells migrate out & can lay dormant for years. Could CAR-T therapy be in the future?
I am trying Paleo diet, exercise & weigh loss to start.

I had RP June 2020. Gleason 4+3, positive margins, spread into bladder neck, and nerve invasion . PSA levels were undetectable post RP until 3 years post surgery. My PSA begin to rise, and within a few months rose from .22 yo .78. When PSA reached .42 I had PSMA Pet scan that showed lymph node metastasis. I had 2 three month ADT injections and opted out after the second. PSA reached a low of .05 while on ADT and T-level reached low of 179. It’s been a year since I stopped ADT. Last levels PSA .07 and T-levels at 330.

@lyricw sounds like a good plan!