Post prostatectomy: What do rising PSA levels mean?

I had a gleason score of 7, had prostate removed and after a month, my PSA was still 2.4. Did we not wait long enough for the PSA to go down or could something else be going on? Previous to surgery the PSA was 18.

I had a gleason score of 7, had prostate removed and after a month, my PSA was still 2.4. Did we not wait long enough for the PSA to go down or could something else be going on? Previous to surgery the PSA was 18.

How can you say everything under 4.0 ng/ml is normal for someone who is post RP?... Everything i have read sugests that anything ABOVE 0.01 (undetectable) is something to pay attention to...

Hello @itterac, Welcome to Connect. From what I've read everything under 4.0 ng/mL is normal. Here's some information I found about your question.

Does Working Out Affect Testosterone Levels?: https://www.webmd.com/men/features/exercise-and-testosterone#1

It sounds like you may be concerned about the rise in your PSA since your radical prostatectomy (RP). Have you asked your doctor about your concern?

What is SRT?

I had recurrence 18 months after surgery so not the same but...time to gather some clinical data to inform a decision between you and your medical team. You should have the Pathology report and your surgeon should have discussed with you his notes. In my case the pathology report was T2CNoMx, GS 4+4, ECE, Margins, and SV Negative, 10% involvement.

Next will be determining PSA doubling and velocity which generally needs three PSA results, there is some discussion about the spacing between those, three months. There are online calculators, Memorial Sloan Kettering has one.

Finally, with a PSA of .7, you may want to image using one of the recently approved FDA scans - https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-second-psma-targeted-pet-imaging-drug-men-prostate-cancer

Informed by that clinical data , your research and your medical team, you can make a decision whether to treat, if so, when and with what. It may be, monotherapy such as radiation or a combined regimen involving radiation and short term ADT, say six months.

I was definitely "disappointed" when my prostate cancer returned after surgery, after I got over the feelings, anger, frustration..I gathered the data and made my next decision. I chose not to "look back" about my decision to do surgery and focus on the next decision I needed to make.

I was diagnosed in Jan 14 at age 57, like your husband, the result of a colonoscopy (PSA was 2.1, my mistake was not having a DRE one during annual physicals but since the PSA was 2.1, who knew...!), surgery in Mar 14, BCR in Sep 15, SRT in Mar 16, then 18 months of ADT, six cycle of taxotere and 25 IMRT to the pelvic lymph nodes. I finished that regimen in August 2018 and it's now three years, other than seeing my urologist every two-four months for labs and consult, no further treatment.

Your husband may have advanced prostate cancer, If so, SRT may "cure" it but there is discussion that the best chance to do so may be at lower PSA than what your husband currently has. This may now be a case of managing a "chronic disease." In the seven years since my diagnosis much has changed, to the better, imaging, treatment modalities,

Kevin

You are living the fear we all have: radiation doing more harm than good? Radiation damage is extremely difficult to deal with; normal surgical techniques often fail since whatever the surgeon touches already has a compromised blood supply.
Even the hyperbaric O2 didn’t work….man, you just didn’t catch a break anywhere…

My numbers started out very low from undetectable too .10 3 months later .19 continual checks kept slow slowly gaining to .55 is when I think we decided to start looking and found that the cancer had returned to areas around the prostate pocket and which is also the base of the bladder. I went almost 2 years after being undetectable again and now March 2025 the numbers have started to gain slowly again. In between the end of the radiation and today, I had quite a year of issues mainly 2024. It started with bladder, neck, bleeding, and catheters to be able to keep from clotting. Incontinence issues throughout the year.
Attempted JP drains to drain the areas where the bladder was feeding the fistula to no avail. Another surgery in October to try to fix the bladder neck area that was having all the issues. They tried omental flap to see if it could heal the damage.Through this process, I was taking 68 hyperbaric oxygen therapy treatments to see if I could help new blood cell growth in that area that was damaged by all of the radiation. The HBO therapy did not seem to have the results we were hoping for. That is when we made the decision to have the cystectomy which was performed February 28. Very relieved of the painful situations I was having throughout 2024. I still have healing going on but nothing like the issues I was dealing with. To top it off infection from the leaking bladder created bacteria that got into my pelvic bones and was almost disabling. High doses of antibiotics prior to and a six week regimen after surgery into mid April.

What type of issues are you referring to?
What was your first PSA number following SBRT?