Post prostatectomy: What do rising PSA levels mean?

Well let me help you relax. My PSA in the fall of 2008 was 2.4 and I had a radical "where they got it all". Two years later the PSA started to rise from the original post surgical >.05 and the decision was made for me to have 40 treatments of radiation in November 2010. It stayed in the .05 – 07 range until the Spring of 2017 when it began to rise (7 years of being good) then in the Fall an Full Body Scan was ordered but it show no detectible spots. It continued to rise until the Fall of 2021 when it was .86 and a Petscan was ordered. It too came back with no detectible locations of cancer cells. In Feb 2022 it has rised to .92 and the urologist said we would look at it in 3 months….we did and it was .94. Then with a retest in December it was 1.92 and I was sent for a PetScan that showed spots on my T4 verterbrae, 2nd rib and in upper right lobe of lung. Decision was made by urologist to send me to radiation oncologist who said he could radiate and KILL all three spots in three sessions. I have completed 2 of the three treatments. In addition the urologist initiated Eligard hormone 6 month shots which I have gotten and I was also sent to a hematologist-oncologist who is starting me in a few weeks on a tertosetone blocking oral medication that will prevent tertosterone from entering and "fueling"the growth of cancer cells. This should put me into somewhat of a remssion for serveal years and when we detect more cancer growth another drug will be started. So it has been 14 years since I first was told I had prostate cancer and I am hoping for 14 more years.

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I wouldn't be too skeptical of that statement. He's not saying if we don't do anything else…, he's saying you'll likely be able to stay in front of it with treatment.

In that PSA range, the percentage of PET's that come back positive are only 30%

I had a negative PET after RP and rise in PSA, still did the 39 radiation treatments and orgovyx (still on it) at age 60/61. PSA was only .093. That didn't even meet most clinical definitions I can find of BCR yet. I think what those two events tell us is that there simply wasn't enough cancer for the scan to see yet.

On the other hand, take winning that round. The test was negative and that's a good thing.

@Kujokujhawk1978 has some great write ups on next step decision making. You and your treatment professionals might want to have that kind of discussion. Something to the effect of when my PSA reaches (insert number here) we'll scan again. At least that gives you a plan to work. As opposed to leaving with just the open ended statement you have here. If you search some of his posts you'll see what I'm referring to.

After reading what I see here (site wide), I'm at a point where I believe the medical folks and I are likely going to be playing a game of "whack a mole" with my PCa for the rest of my days. I'd love to be wrong! but….I've sort of rallied myself to this being a possibility. Do I think this will take me out? likely not, it's just going to be a PITA going forward.

On the other hand, I have friends with the same grade cancer as me that only did radiation for treatment and have had their PSA stay down for over 10+ years to date. It seems no two cases are exactly alike.

Best of luck to you!

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ALL DONE with my three radiation sessions today….now have to wait until May to hve Catscan done to see if it killed off all the cancer cells in the three spots.

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Very helpful

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Yes and no…the medical community in the past few years revised the grading system…

A 5 Grade Group System was created to have a better way to describe how a cancer will behave and respond to treatment.
Grade group 1: Gleason score 6 or lower (low-grade cancer)
Grade group 2: Gleason score 3 + 4 = 7 (medium-grade cancer)
Grade group 3: Gleason score 4 + 3 = 7 (medium-grade cancer)
Grade group 4: Gleason score 8 (high-grade cancer)
Grade group 5: Gleason score 9 to 10 (high-grade cancer)

A lower group indicates a better chance for successful treatment than a higher group. A higher group means that more of the cancer cells look different from normal cells. A higher group also means that it is more likely that the tumor will spread aggressively.

So, you re more likely…then again, you may have been in the less likely. My pathology report said GS 4+4 which when I fed the data from the pathology report into MSKCC's nomogram, margins, SV, ECE…it said 30% chance of BCR. Statistically that also meant a 70% chance it would not. Alas, I was in the 30% and thus why I am not a gambler.

What it does mean I think is you and your medical team should consider more aggressive treatment if the clinical data supports it.

I may be facing a similar decision, labs today, if my PSA goes up again, my radiologist, urologist and I agree it may be time to scan and then decide based on the results, my labs and clinical history. One thing we do know, one's PCa does not get "less" over time in terms of the grade group.

Kevin

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was diagnosed with prostate cancer in 2013–recommendation was radical removal of prostate as best treatment as it appeared cancer was localized in prostate -(horse was in the barn my Dr said) so get rid of barn and problem goes away. Prostate was removed and PSA was 0.0–all good until 2022 mid year discovered PSA had climbed to 2.6–talked to Dr who did my surgery and recommended biopsy of area where prostate was—results came back positive for cancer in prostate area. Radiation was recommended and 35 treatments were performed over app 2 month time frame—PSA now at 0.0 again. I just had some blood work done yesterday 9Feb23, (6 months after surgery) am awaiting results which should be available 13 Feb 23. Fingers crossed

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Next steps – gather clinical data, consider bringing a radiologist and oncologist on to your team, a multi-disciplinary approach.

Gather the clinical data to inform any decision between you and your medical team to start treatment – at what PSA, will PSA doubling and velocity times be a factor, when and with what will they image…will they do any genomic testing…?

Having that type of clinical data combined with your personal health and preferences for quality of life, aggressive treatment or not…can inform any decision between you and your medical team.

The imaging could show recurrence in only the lymph nodes, if so, how many and where. Or, it could show bone and, or organ involvement. If so, where…depending upon the PSADT and PSAV, you and your medical team may decide to not doing anything and continue to actively monitor, if the PSADT

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