Post prostatectomy: What do rising PSA levels mean?

Posted by hoard @hoard, Sep 10, 2019

New to group! Wish I had checked this out 2 years ago while supporting my husband! Now over e years post prostatectomy, wondering what might make psa go from all 0 to 2.6…

Interested in more discussions like this? Go to the Prostate Cancer group.

@candcman

Hello Colleen. I had my prostate removed September of 2019. Robotically! Awesome process! PSA level before surgery was 7.50. 3 months after surgery 2.50. Finished radiation treatments May 14th 2021. One month after radiation PSA is 3.28. Do we think this just to soon to check my numbers or should I be concerned?

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Hi Candcman, and welcome. I can understand your concern about a rising PSA so soon after treatment. I'm not qualified to answer whether it is too soon to check your numbers yet. But I will uncategorically say that that is a good question to ask your oncologist or nurse manager. They are best equipped to tell you when to get tested. @kujhawk1978 @ken82 @dandl48 @ozment @semeon may have some advice and experience to share with you.

Candcman, are you able to contact your cancer care team through a patient portal?

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@colleenyoung

Hi Candcman, and welcome. I can understand your concern about a rising PSA so soon after treatment. I'm not qualified to answer whether it is too soon to check your numbers yet. But I will uncategorically say that that is a good question to ask your oncologist or nurse manager. They are best equipped to tell you when to get tested. @kujhawk1978 @ken82 @dandl48 @ozment @semeon may have some advice and experience to share with you.

Candcman, are you able to contact your cancer care team through a patient portal?

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@candcman @colleenyoung I would second Colleen's suggestion to contact your oncologist re the PSA increase. They didn't express any concerns when they gave you the results of your recent PSA test?

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It's your choice, but…with a PSA of 2.5 after surgery instead of <.1 it means your PCa was advanced, outside of the prostate, possible the lymph nodes, though not impossible to include bone or organs. Was there any imaging done o try and determine where the recurrence was after surgery. Since you had surgery, you have a pathology report, sharing that with the forum will help members with their advice. In My case, it was T2CNoMX, SV, ECE, Margins negative, GS 8.

From what you say it seems your had SRT, was it to the prostate bed only or did it include the PLNs?

Al this is irrelevant now, question is, what to do now…

First, I would ask your medical team to schedule imaging to locate the site(s) of your PCa. At your PSA, any of the FDA approved ones will likely determine where it is.

You can have your PSA checked again, 30-90 days, it would tell you whether or not the rise is a continuous upward trend or a increase that can occur after radiation and then it goes down.

Informed by clinical data – your pathology report, PSA results which can be used to calculate PSADT and PSAV and the imaging, you and your medical team can make a decision on treatment, if, when to initiate and what. If your decision is to treat, you will have choices so consider what the clinical data tells you but most likely monotherapy will not be the answer, you will want to consider a combined regimen.

Kevin

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@kujhawk1978

It's your choice, but…with a PSA of 2.5 after surgery instead of <.1 it means your PCa was advanced, outside of the prostate, possible the lymph nodes, though not impossible to include bone or organs. Was there any imaging done o try and determine where the recurrence was after surgery. Since you had surgery, you have a pathology report, sharing that with the forum will help members with their advice. In My case, it was T2CNoMX, SV, ECE, Margins negative, GS 8.

From what you say it seems your had SRT, was it to the prostate bed only or did it include the PLNs?

Al this is irrelevant now, question is, what to do now…

First, I would ask your medical team to schedule imaging to locate the site(s) of your PCa. At your PSA, any of the FDA approved ones will likely determine where it is.

You can have your PSA checked again, 30-90 days, it would tell you whether or not the rise is a continuous upward trend or a increase that can occur after radiation and then it goes down.

Informed by clinical data – your pathology report, PSA results which can be used to calculate PSADT and PSAV and the imaging, you and your medical team can make a decision on treatment, if, when to initiate and what. If your decision is to treat, you will have choices so consider what the clinical data tells you but most likely monotherapy will not be the answer, you will want to consider a combined regimen.

Kevin

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@kujhawk1978

It's your choice, but…with a PSA of 2.5 after surgery instead of <.1 it means your PCa was advanced, outside of the prostate, possible the lymph nodes, though not impossible to include bone or organs. Was there any imaging done o try and determine where the recurrence was after surgery. Since you had surgery, you have a pathology report, sharing that with the forum will help members with their advice. In My case, it was T2CNoMX, SV, ECE, Margins negative, GS 8.

From what you say it seems your had SRT, was it to the prostate bed only or did it include the PLNs?

Al this is irrelevant now, question is, what to do now…

First, I would ask your medical team to schedule imaging to locate the site(s) of your PCa. At your PSA, any of the FDA approved ones will likely determine where it is.

You can have your PSA checked again, 30-90 days, it would tell you whether or not the rise is a continuous upward trend or a increase that can occur after radiation and then it goes down.

Informed by clinical data – your pathology report, PSA results which can be used to calculate PSADT and PSAV and the imaging, you and your medical team can make a decision on treatment, if, when to initiate and what. If your decision is to treat, you will have choices so consider what the clinical data tells you but most likely monotherapy will not be the answer, you will want to consider a combined regimen.

Kevin

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Psa .25 not 2.5. 3 years post rp. Tc3a. 7 4/3 . in one lymph node not in pelvic

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@kujhawk1978

It's your choice, but…with a PSA of 2.5 after surgery instead of <.1 it means your PCa was advanced, outside of the prostate, possible the lymph nodes, though not impossible to include bone or organs. Was there any imaging done o try and determine where the recurrence was after surgery. Since you had surgery, you have a pathology report, sharing that with the forum will help members with their advice. In My case, it was T2CNoMX, SV, ECE, Margins negative, GS 8.

From what you say it seems your had SRT, was it to the prostate bed only or did it include the PLNs?

Al this is irrelevant now, question is, what to do now…

First, I would ask your medical team to schedule imaging to locate the site(s) of your PCa. At your PSA, any of the FDA approved ones will likely determine where it is.

You can have your PSA checked again, 30-90 days, it would tell you whether or not the rise is a continuous upward trend or a increase that can occur after radiation and then it goes down.

Informed by clinical data – your pathology report, PSA results which can be used to calculate PSADT and PSAV and the imaging, you and your medical team can make a decision on treatment, if, when to initiate and what. If your decision is to treat, you will have choices so consider what the clinical data tells you but most likely monotherapy will not be the answer, you will want to consider a combined regimen.

Kevin

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Disregard thought u were talking about my post

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Good afternoon! I apologize upfront for the lengthy post. I'm trying to wrap my mind around the whirlwind of my husband's (age 51) recent diagnosis of prostate cancer that was suprisingly found during his colonoscopy. Prior to the colonoscopy, my husband had a PSA of 3.1. His primary never suggested further testing because of it. During his routine colonoscopy, the GI came out to talk to us to let us know that he found a nodule on prostate during exam and sent referral to urologist. After appointment and finally biopsy, it was determined he had prostate cancer. Multiple Gleason 3+4 and one core 8 on biopsy. Also perineural invasion present. Had prostatectomy in 11/20. First post PSA .1 in 2/21. Had followup PSA in 5/21 was .6. (Physician wanted to retest due to recent COVID vaccine). Had another PSA on 6/21. This time was .7. He was sent for PET scan this past Friday which came back negative. Urologist referred to in house radiation oncologist. Appointment was yesterday. I asked nurse before he came in if my husband has radiation now could he have it again down the road if there is recurrence. She said that would be a question for the doctor. When he finally came in the room, the first words from his mouth were "this is his best, last chance." Needless to say, my husband and I both were in complete shock…. I have since contacted Moffitt and we have an appointment Tuesday. Has anyone had a rising PSA so soon after surgery? If so, what type of additional treament did you have? While hearing cancer is terrifying, we did not think the outlook was terrible until our visit with the physician yesterday. Any insight would be greatly appreciated.

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@canes4always

Good afternoon! I apologize upfront for the lengthy post. I'm trying to wrap my mind around the whirlwind of my husband's (age 51) recent diagnosis of prostate cancer that was suprisingly found during his colonoscopy. Prior to the colonoscopy, my husband had a PSA of 3.1. His primary never suggested further testing because of it. During his routine colonoscopy, the GI came out to talk to us to let us know that he found a nodule on prostate during exam and sent referral to urologist. After appointment and finally biopsy, it was determined he had prostate cancer. Multiple Gleason 3+4 and one core 8 on biopsy. Also perineural invasion present. Had prostatectomy in 11/20. First post PSA .1 in 2/21. Had followup PSA in 5/21 was .6. (Physician wanted to retest due to recent COVID vaccine). Had another PSA on 6/21. This time was .7. He was sent for PET scan this past Friday which came back negative. Urologist referred to in house radiation oncologist. Appointment was yesterday. I asked nurse before he came in if my husband has radiation now could he have it again down the road if there is recurrence. She said that would be a question for the doctor. When he finally came in the room, the first words from his mouth were "this is his best, last chance." Needless to say, my husband and I both were in complete shock…. I have since contacted Moffitt and we have an appointment Tuesday. Has anyone had a rising PSA so soon after surgery? If so, what type of additional treament did you have? While hearing cancer is terrifying, we did not think the outlook was terrible until our visit with the physician yesterday. Any insight would be greatly appreciated.

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Good evening @canes4always …..Welcome to Connect. We are focused on the benefits of sharing information and personal stories with each other. Knowledge is power and the more we know, the better we can make good decisions about our health and well-being.

I can see that you are shocked and frustrated. We all sometimes think that surgery will be the cure-all. Unfortunately, that is not always true. Your husband is quite young to begin dealing with prostrate issues which makes the situation even more disheartening.

I noted your post because I have been and still am a caregiver for my life partner. His first PSA rise led to a robotic surgical removal of the prostate. Just as we were beginning to relax a bit, his PSA started climbing again. He was called back to Mayo in Rochester for what I would call a thorough diagnosis. Come to find out, a small piece of tissue with cancer had fallen into the prostate bed during the surgery. Since it was still localized without any spread to other areas, the decision was made to spend 30 days receiving very targeted beam radiation.

So off we went to spend the holidays at Hope Lodge for treatment. That was the perfect place to stay because all patients housed there were cancer patients from around the world with unique stories about their journeys. The reality of shared conditions led to a group of warm and genuine relationships. Even members of the Rochester community paid us visits, prepared meals for us, and sang Christmas carols.

That was three years ago and since that time his PSA has been undetectable. His prostate oncologist was jumping for joy a few weeks ago when he went in person for an in-person check-up.

It is my sincere hope that the answers you receive will be just as reassuring. Has a date been set for a consultation?

May you be free, safe, and protected from harm.
Chris

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@canes4always

Good afternoon! I apologize upfront for the lengthy post. I'm trying to wrap my mind around the whirlwind of my husband's (age 51) recent diagnosis of prostate cancer that was suprisingly found during his colonoscopy. Prior to the colonoscopy, my husband had a PSA of 3.1. His primary never suggested further testing because of it. During his routine colonoscopy, the GI came out to talk to us to let us know that he found a nodule on prostate during exam and sent referral to urologist. After appointment and finally biopsy, it was determined he had prostate cancer. Multiple Gleason 3+4 and one core 8 on biopsy. Also perineural invasion present. Had prostatectomy in 11/20. First post PSA .1 in 2/21. Had followup PSA in 5/21 was .6. (Physician wanted to retest due to recent COVID vaccine). Had another PSA on 6/21. This time was .7. He was sent for PET scan this past Friday which came back negative. Urologist referred to in house radiation oncologist. Appointment was yesterday. I asked nurse before he came in if my husband has radiation now could he have it again down the road if there is recurrence. She said that would be a question for the doctor. When he finally came in the room, the first words from his mouth were "this is his best, last chance." Needless to say, my husband and I both were in complete shock…. I have since contacted Moffitt and we have an appointment Tuesday. Has anyone had a rising PSA so soon after surgery? If so, what type of additional treament did you have? While hearing cancer is terrifying, we did not think the outlook was terrible until our visit with the physician yesterday. Any insight would be greatly appreciated.

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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

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@canes4always

Good afternoon! I apologize upfront for the lengthy post. I'm trying to wrap my mind around the whirlwind of my husband's (age 51) recent diagnosis of prostate cancer that was suprisingly found during his colonoscopy. Prior to the colonoscopy, my husband had a PSA of 3.1. His primary never suggested further testing because of it. During his routine colonoscopy, the GI came out to talk to us to let us know that he found a nodule on prostate during exam and sent referral to urologist. After appointment and finally biopsy, it was determined he had prostate cancer. Multiple Gleason 3+4 and one core 8 on biopsy. Also perineural invasion present. Had prostatectomy in 11/20. First post PSA .1 in 2/21. Had followup PSA in 5/21 was .6. (Physician wanted to retest due to recent COVID vaccine). Had another PSA on 6/21. This time was .7. He was sent for PET scan this past Friday which came back negative. Urologist referred to in house radiation oncologist. Appointment was yesterday. I asked nurse before he came in if my husband has radiation now could he have it again down the road if there is recurrence. She said that would be a question for the doctor. When he finally came in the room, the first words from his mouth were "this is his best, last chance." Needless to say, my husband and I both were in complete shock…. I have since contacted Moffitt and we have an appointment Tuesday. Has anyone had a rising PSA so soon after surgery? If so, what type of additional treament did you have? While hearing cancer is terrifying, we did not think the outlook was terrible until our visit with the physician yesterday. Any insight would be greatly appreciated.

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Hi Canes4always, please note that I moved your message to this related discussion called:
– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/

Reading through the past messages, you'll get information from fellow members in addition to the great responses you've already gotten from @artscaping and @kujhawk1978

Canes, how are you doing today?

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@colleenyoung

Welcome to the Prostate Cancer group, @hoard.
You ask a good question. What can rising PSA levels means years after having had a prostatectomy?
There are several reasons why one's PSA level may rise after being stable for a time. This article explains it well:
– PSA levels after prostatectomy https://www.medicalnewstoday.com/articles/323899.php

Here's an excerpt from the article:
"Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.

In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include:
– older age
– ethnicity
– medication
A doctor will take these factors and the person's medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern."

The PSA test alone is not enough to determine cause or next steps. Your doctor will likely consult with your husband and possibly order other tests. How long ago did your husband have his surgery? Did he have other treatments after surgery? Do you have a followup appointment schedule with his oncologist?

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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.

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@itterac

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.

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

How are you feeling? How is radiation going?

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