Post prostatectomy: What do rising PSA levels mean?

Rp 4/18. 7-4/3. Bcr 1/21. then 36 radiation treatments plus orgovyx. Bcr 12/22-.26, psa 2/23-.32 Psma pet scan neg- 4/23. Any recommendations. My urologist said w neg pet , I have a 0% chance of dying fm pc. I’m skeptical of his opinion.

Congrats on completing your treatments. Good luck with all your test results.

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.

Very helpful

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.

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

Will do at next appt. Does second bcr after rp salvage and adt mean my 7 4/3 is particularly aggressive?

Great!

Yes. They have discussed PSA doubling time and rise and scans and testing. I’m just not ready for further treatment.

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