Post prostatectomy: What do rising PSA levels mean?

Hello @jjmack and welcome to Mayo Clinic Connect. Thank you for joining the discussion and sharing your personal journey with incontinence so that others may as well. Members such as @scullrower and @ch665296f have both shared the same and may have some additional information they can pass to you.

Additionally, you'll find other men talking about this issue in this discussion:
– Does anyone still have leakage? https://connect.mayoclinic.org/discussion/does-anyone-still-have-leakage/

What have you been doing to see the improvements you have to date?

Hi All, I'm new here. I have found reading this forum very informative. I was diagnosed in January 2021 with PSA of 28. Had not had it checked since 2014. Bit of a shock. Short version - had robotic radical prostatectomy in May 2021. T3bNO, Gleason 5/4, 18cc. Pre-surgical PSMA showed seminal vesicle invasion, but no spread anywhere else. Monthly post-surgical PSA results of 0.17,0.12,0.23, 0.24. Recent PSMA post shows undetectable including prostrate bed. Because of high grade pre-surgery, radiologist is recommending 6 months ADT and SRT. Here's my question, I have been fighting incontinence since surgery. I have reduced from 4 cups leakage per day to about 1/2 cup (200g). If measured in "pads", this is 4-5 soaking wet pads down to 3 pads changed for convenience (e.g. after workout, etc.). Any thoughts on postponing SRT to gain more continence. I find that there isn't much talk about continence at support groups and maybe I'm whining to much, but it really is a QoL consideration.

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Colleen young. How do I unsubscribe fm all blogs and highlights. Only want to follow Pc.

Great information! Thanks

No reason to hit the panic button. You may want to consider having several more USPSA tests 90 days apart to determine if the change is a continuous upward trend or fluctuations. If those tests continue to rise then you may have other decisions to consider with your medical team. You will want to gather clinical data...

The first may be whether to image, when, at what PSA and with what? The PSMA scans recently approved by the FDA can detect at <.5 but as your PSA goes up, so does their detection rate.

If your PSA continues to rise then you can calculate PSDAT and PSAV.

You may want to discus Genomic testing with your medical team.

Informed by clinical data, you and your medical team can make a decision about treatment, whether to and if, when to initiate, with what, for how long, how to monitor response...

In my case, I was diagnosed in Jan 14, had RP in March 14, BCR in Dec 15, SRT in Mar 16 then in Jan 17 did 18 months of ADT, six cycles of taxotere and 25 IMPRT to the PLNs, finished treatment in May 18.

My PSA has fluctuated over the last three years. My medical team and I continue to monitor every 2-4 months and have decision points:

Need three or more tests 90 days apart with continuous rise and calculate PSADT and PSAV.

Image between .5-1.0

Then decide on treatment.

Here's my recent PSA tests:

2018

12 February 2018 Testosterone <7, PSA <.1 (Mayo)
27 April 2018 Testosterone <3, PSA <.1 (SMC)
1 August 2018 Testosterone <3 PSA <.1 (SMC)
30 October 2018 Testosterone 135 PSA <.1 (SMC)

2019

2 February 2019 Testosterone 481, UPSA .36 AHC
16 February 2019 USPSA (AHC) .3
2 April 2019 USPSA KCUC .06
7 June 2019 (USPSA KCUC).124
19 August (USPSA KCUC) .06

2020

3 January 2020 USPSA (KCUC) .07
5 May 2020 USPSA (KCUC) .07
4 August 2020 USPSA (KCUC) .09
5 November 2020 USPSA (KCUC) .16

2021

5 February 20221 USPSA (KCUC) .29
30 April 2021 USPSA (KCUC) .3
12 July 2021 USPA (KCUC) .17

Kevin

Had prostate removed 2 1/2 years ago. No cancer beyond prostate. Have had undetectable psa until now. 0.06. Should I have a second blood test? Concern?

Feeling ok. Lower energy level but that’s mainly fm the adt. Radiation progressing nicely

Treatment appears to be having the desired effect. :: Thumbs up ::

How are you feeling? How is radiation going?

I would like to update my treatment. Been on orogovyx for 78 days. Testosterone down fm 255 to 42. Have had 8 of 36 srt, psa down fm .28 to undetectable. Appears to b good signs. Comments please.