Post prostatectomy: What do rising PSA levels mean?

@samadhi, you've received a lot of helpful replies from members. Is your oncologist concerned about the rise in PSA levels? Are you currently taking any treatment or is treatment being discussed at this level?

I won’t call it luck but I will agree that I’ve been fortunate, even blessed. I’m fortunate that I found great care at Northwestern Medical in Chicago. I’m fortunate that my care team includes some of the most competent and compassionate people I ever hoped to meet. I’m fortunate that they’ve figured out improved ways to detect PCa beyond the 2019 study you cited. I’m fortunate that my known metastasis on recurrence was limited to two pelvic lymph nodes and that I was a candidate for salvage RP after failed focal brachytherapy 2020. I’m fortunate that the cancer that they were unable to reach and remove during salvage RP this January still showed up on the subsequent PET-PSMA scan with only a 0.44 PSA reading and is being used to guide my upcoming salvage RT.

I wish you success on your journey with PCa and hope you wish me the same success.

38% chance of detection at .4 PSA per the internet. 87% chance of detection when > 4.0 PSA. Look this up . You got lucky.

Thanks for sharing the charts. As I have been on this journey with recurrent PCa and as a retired engineer/scientist, I try and read as many relevant publish medical papers as possible. I fully understand and appreciate that a when a scan is done on a patient having lower PSA, the scan may not be sensitive enough to reveal all the lesions present within a patient’s body, especially if the prostate is still present within the body. At any level of PSA, it’s one of the best tools that’s ever been available in helping to diagnose PCa and guide treatment protocol.

Best wishes for success on your personal journey.

Correction: Post RP PSA target < .1
(not < .01)
Following Salvage Treatment Rad Onc ordered Ultrasensative PSA testing and 6 and 9 mos uPSA has been < .02 (Quest Labs limit of detection therefore deemed "undetectable").
Coincidentally, had uPSA blood draw this morning for 3rd post treatment uPSA, now 12 months since Salvage Tx completed May/June 2023.
Best to all.

3td and final

A 2nd one

Here's one chart, I'll add two others since the software only allows you to upload one at a time

Respectfully my personal experience partially refutes the opinion of your oncologist. My PSA was 0.44 after RP. PET-PSMA clearly showed lymph node involvement. It is my understanding however that cancerous lesions may not show up on a scan if they are less than 10 cm in any direction.

I hope you’re being treated at a center of excellence. If you’re not or don’t have confidence in your own oncologist, I suggest that you consider investigating another care provider. Best wishes for success on your journey.

What does your riding PSA mean, likely there is prostate cancer somewhere.

Question is:

Treat, yes or no?
If yes, when?
If yes , with what and for how long?

To make those decisions you have two choices:

Treat solely on PSA
Wait, image, then informed by the results and other clinical data, decide....

You could read through the NCCN guidelines, they are the science that guides patients and doctors in treatment decisions. Keep in mind they are population based and clinical trials are rapidly changing the landscape of what we know.

At your PSA in Jan 23, you had less than 1/3rd chance of locating anything.

There is no doubt imaging can inform treatment decisions. The questions you have to ask yourself in conjunction with your medical team are:

Will it change our treatment decision?
Will waiting for my PSA to rise, say between .5-1, change the outcome of your treatment?

Search for doublet or triplet therapy, those are more and more mainstream treatment decisions for advanced PCa.

Your future may hold ADT plus an ARI, maybe chemotherapy with those or add radiation to the prostate bed and whole pelvic lymph nodes (I would not do only the prostate bed, that was my epic failure with SRT!)

In part, your treatment decision may rest on several factors:

How aggressive you want to be.
Your risk tolerance for waiting for PSA to rise for imaging?
Overall health , any co-morbidities
Insurance, financial toxicity.

So, you have some work to do to inform yourself, discuss with your medical team and decide together, you and your medical team. The good news, a myriad of choices, the "bad" news, a myriad of choices, You will not be able to know the outcome if your decision until time has passed. As I say, I am a study if one, no clone to test out treatment decisions, no way of coming back in time to say, "that worked!"

Something to think about, whatever treatment decision you decide on, it may be for a defined period, say ADT for 18-24 months vice a continuous and lifelong sentence (see my clinical history).

There's the science - NCCN guidelines, clinical trials, levels of evidence...then the art, how to use the science based on your clinical data!

The forum may not be able to give you a definitive answer, there is not one.

Attached is my clinical history. I have generally chosen aggressive approaches though the SRT was not, only because I let my medical team talk me out of an aggressive approach, the last time that happened!

Kevin