Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?

Took me 3 1/2 years before my PSA started to rise after a prostatectomy.

I know people that have gone 10, 15 and 25 years Before their PSA started rising significantly.

Yours has not risen significantly. It is a minor rise. Salvage radiation isn’t recommended until you hit .2. It’s just as likely to go down next month, go up, or stay the same.

If you did not get an ultra sensitive PSA you would’ve seen <.1 and not even been concerned.

I fully concur with Jeff.

With only one elevated PSA result, there is no certainty to this being an actual rise (vs “lab variation”), even though it naturally induces alarm/concern.

I completed salvage radiation for a local recurrence last November. My prostectomy was in 2015 and I went ten years with undetectable PSA (<0.1) until June 2025 when it rose to 0.11.

Just before starting radiation therapy, I switched to the Labcorp ultra sensitve PSA test. Going into radiation my PSA was 0.097. At three months after radiation (Feb 2026) it was 0.086. Then in May 2026, it bounced up to 0.113 (and yes, I was concerned). Since then I have done two more tests, which yielded 0.100, then 0.090. So, now I am trending down after an abrupt rise of 0.27. Was the rise real or just lab a variation? Hard to say at this point. Only time and continued testing will tell. My urologist, who is an advanced prostate cancer specialist said that the post RT PSA results indicate that my PSA is “low and stable”. I’m good with that.

If the 0.02 result is weighing heavy on your mind, there is no harm in repeating the test now to see if it is a lab fluke. Otherwise, I would advocate with my doc(s) to test monthly until a clear trend (up, down, or stable) emerges. Some docs might brush off the new test result, others may say let’s retest and level up the frequency. If you have the brush off type of doc (I have, in the past), advocate firmly for what you want to happen next. I once even went to my PCP to get a test order when my then urologist was uncooperative.

However you proceed, I feel your anxiety. Both good news and bad news that you are in a state of uncertainty at the moment.

@melvinw
My concern has always been the level of 'high risk' that was diagnosed post surgery. Prior to surgery, my PSA was elevated (6) but stable for 3 years, so it was a 'wait and see'. Then it began to rise quickly with a doubling time of about 3 months. That is when the decision was made to act. I am hoping this is not a repeat of that scenario (i.e stability then surge). Your PSA of .09 seems low to have begun radiation. My impression was they do not consider a true BCR until .2 is reached? There seem to be so many opinion variations on this. I am a University of CA patient and they had said initially "if it goes up, we begin Lupron". That was 5 or so years ago so I am thinking they have adjusted thinking since then.

@jeffmarc
Thank you Jeff. I have followed your comments over the past few years and always appreciate them. Were you 'high risk' initially? Are you pleased with the treatment path your physician chose for you?
Thanks, Tom

@tom86 To flesh out my relapse, yes my PSA was low relative to the conventional cutoff of 0.2. The kicker was that in 2023, a small nodule was detected in my prostate fossa during a digital rectal exam. My PSA remained undectable until June of 2025, when it rose to 0.11. A PSMA PET scan was ordered and the nodule lit up with an SUMmax of 13.3. No evidence of distant mets. A follow up pelvic MRI was consistent with the PET scan, and also showed no lymph node involvement. Again, an anamolous situation given that PSMA PET scans have a relative low probablity of detecting cancer when PSA <0.5. Without the old school finger exam, I may well be on active surveillance with a little ticking time bomb. My salvage RT was an early intervention in one sense, but then it wasn’t just a BCR but a palpable lesion. My urologist and radiation oncologist both felt strongly the immediate therapy would increased the odds of success. I concurred.

Btw, my post-prostatectomy pathology was Gleason 3+4, Grade 2Tc, with one positive margin. Prolaris Score gave a 53% chance of BCR in ten years.

Hope your recent PSA bump is not the start of another surge. Seems the best any of us can do is to stay on top of monitoring, and make no assumptions about what is or isn’t coming next.

Yes, the use of ADT has evolved a good bit in the last five years, and continues to evolve. Radiation therapy has evolved as well. Huge brain trust here for all that.

@melvinw
Interesting you would mention the DRE as finding your 'hidden' issue. I can't get them to do a DRE. In fact, I have had no physical follow up whatsoever. They say with no PSA, no need for a DRE. Maybe now, they will do one. I am beginning to realize you have to be your own advocate as they see so many patients you just become a name on a list. Sad, but true. Sloan Kettering gave me a 90% chance for no BCR for first 7 years, 4 months ago. Only statistics. Thank you for your reply and perspective.

The urologist who performed my prostectomy did a DRE with every PSA test until he retired 9 years later. There appears to be a move away from DREs, I guess because many guys don’t like them and they are “too subjective.” They never really bothered me, especially compared to a transrectal needle biopsy. Anyway, I hope my story provides you with sufficient reason to counter the “no PSA, no need for a DRE”. Maybe statistically that has some merit, but I’m living proof that it is not invariably true. Yup, self advocate firmly.

It was 3 years when my PSA changed and was .15 when I had 6 months of adt and 38 sessions of IMRT which was completed 7 weeks ago. My lab only went down to .02 so all my readings were <.02 originally. My Gleason 7, 3 4, had cribform, and 2 indeterminable margins. While BCR is .2 there are places using .1 if it is aggressive. They took a decipher test and it was .92 making it aggressive. You might want to get a decipher test. When they looked back at my margins it appeared the cancer did get past the margin at the bladder neck and wth the high decipher they did radiation treatment at .15 PSA
Wishing you luck and hope the PSA stays low

To put it into absolute clarity: a 0.02 PSA is a 100% increase over a 0.01 PSA. It is more significant than you think. Your urologist will likely do one of two things: 1) Refer you immediately to a radiation oncologist to discuss potential and likely radiation therapy, or...2) Start monitoring your PSA every three months again. He may order "ultra-sensitive PSA" tests instead so he can really monitor very subtle increases.
I too am/was a pT3b with left seminal vesicle (only) invasion. My PSA was only 6.1 though and I was a Gleason 3 + 4 = 7 with <10% of cells being grade "4." Good luck to you.

I am 2+ years post-surgery. My PSA has been < detect since then. My doctor said that even if does come back, it will be so slow growing that there would be plenty of time to address it. I interpreted that as he expects i'll die of something else before it's a problem. But more importantly, the PSA level would have to be high enough to identify exactly where it was occurring so that they could target treatment appropriately. That is, no general blasting of the area with radiation without a target.