Post prostatectomy. 1st PSA at .30, 2nd PSA at .43, future prognosis?

Your doctor is giving you the best advice. After a prostatectomy, your PSA should hit Undetectable. Mine stayed undetectable for 3 1/2 years before it started rising, and I had to have salvage radiation.

You do need salvage radiation, but will have to wait until you surgery has fully healed. Going on ADT is really the best choice you can make. It’s not unusual for the PET scan to show nothing this early in treatment.

Just so you see what the recommendations are by The American Society of clinical oncology (ASCO)

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.

He gave you an excellent answer. I had watched videos taken at symposiums about prostate cancer. The androgen deprivation therapy prior to radiation is believed to make the cancer cells more susceptible to the effects of radiation. Also, the side effects resulting from radical prostatectomy can be compounded with radiation therapy, and the combination can result in long-term side effects. They prefer the patient to have good urinary control prior to radiation treatment.
I had surgery about 17 months ago. My first PSA at about 6 weeks post surgery was < .04. That lasted for 9 months. It then went to .04. I went 3 months later and it is now .06. So, I go again in 3 months, and we will then talk about the future plan of action.
I'm not a medical professional.
I was disappointed when I saw my PSA go from less than to .04 then to .06. I am 17 months out of surgery. Any steady increase in PSA is always concerning. I plan on going on ADT for about 3 months then starting radiation. We'll see what the professionals think about my plan of action. I do not want to wait until I am .20 PSA. I will go at .10 as I had extra prostatic extension and Gleason 9.
Wishing you health.

He gave you an excellent answer. I had watched videos taken at symposiums about prostate cancer. The androgen deprivation therapy prior to radiation is believed to make the cancer cells more susceptible to the effects of radiation. Also, the side effects resulting from radical prostatectomy can be compounded with radiation therapy, and the combination can result in long-term side effects. They prefer the patient to have good urinary control prior to radiation treatment.
I had surgery about 17 months ago. My first PSA at about 6 weeks post surgery was < .04. That lasted for 9 months. It then went to .04. I went 3 months later and it is now .06. So, I go again in 3 months, and we will then talk about the future plan of action.
I'm not a medical professional.
I was disappointed when I saw my PSA go from less than to .04 then to .06. I am 17 months out of surgery. Any steady increase in PSA is always concerning. I plan on going on ADT for about 3 months then starting radiation. We'll see what the professionals think about my plan of action. I do not want to wait until I am .20 PSA. I will go at .10 as I had extra prostatic extension and Gleason 9.
Wishing you health.

Hi Mike, I'm in a similar boat. Prostatectomy was 9 months ago, with positive surgical margins. Four months after surgery my PSA was 0.24, and nine months after surgery (now) it is 0.37. I'm told it is a high-risk local recurrence, and the PET scan was inclusive but might show small cancer in pelvic lymph nodes.

I'm starting ADT two days from now, and seven weeks of radiation therapy starting in late October. My ADT is going to include two years of ARPI, androgen receptor pathway inhibitor.

Radiation therapy comes several weeks after ADT has started, since that way the cancer cells will be weakened beforehand by the testosterone deprivation.