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.

@jic811

Thanks. Appt with oncologist at Vanderbilt tomorrow.

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That’s great. I’ll be interested to hear what you learn tomorrow.

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@colleenyoung

Hi @aakrogstad and welcome. A rise in PSA, however slight so easily creates concern. I can imagine you're scared. I'm tagging @dandl48 @hoard @horace1818 and @ken82 to offer their thoughts.

A single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. Your doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.

The waiting part is the hardest. Do you have ways to distract your thoughts or calm them?

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My prostectomy was 17 years ago. My psa level was undetectable until my recent test. It is now elevated.
Kenw

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@kenw

My prostectomy was 17 years ago. My psa level was undetectable until my recent test. It is now elevated.
Kenw

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Hi @kenw and welcome to Mayo Clinic Connect. I am sorry for your rising PSA levels.
Can you share more about your story with us? What did your MD say about your elevation?

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@amandaburnett

Hi @kenw and welcome to Mayo Clinic Connect. I am sorry for your rising PSA levels.
Can you share more about your story with us? What did your MD say about your elevation?

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Dr. Said that 0.56 psa was a cause for concern and recommended I see a urologist.
Kenw

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That's a starting point…17 years post RP is a good run.

So much has changed since then, heck, so much has changed since I was diagnosed in 2014…!

While you're waiting to see a urologist, may be time to catch up. Some start8ing points:

The NCCN Guidelines:

Early stage – https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=49

Advanced Stage – https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=50

The Prostate Cancer Foundation – https://www.pcf.org/guide/prostate-cancer-patient-guide/

Inform yourself on current FDA approved imaging, may be useful in your decision making process to locate any recurence.

There are four you may want to consider reading about, much has improved since the days of CT and MRI that I had in 2014.

C11 Choline
Aximun – https://www.petimagingflorida.com/pet-imaging-is-proud-to-offer-axumin-pet-scans/
PSMA 68 Gallium – https://www.pcf.org/blog/breaking-news-fda-approves-a-highly-sensitive-prostate-cancer-imaging-agent/
PSMA PET imaging agent 18F-DCFPyL – https://www.urologytimes.com/view/fda-approves-psma-pet-imaging-agent-18f-dcfpyl-for-prostate-cancer.

The PSMA ones are generally more sensitive at lower PSA, with a PSA of .5 -1 you could image and perhaps locate any recurrence.

You'll want to gather more clinical data – more PSA tests to gauges doubling and velocity times.

Informed by clinical data through imaging and PSA tests, combined with age, health and life expectancy, you can then make an informed decision about whether to treat, when and with what.

The imaging may provide information on where the recurrence is – prostate bed, lymph nodes, bones, organs…
The PSA tests may provide information on PSAT and PSAV, indicating aggressiveness.

If your decision is to treat, you'll have a wide set of choices that can range from mono therapy to combined regimens and can be short term, six months to several years or more.

Kevin

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Hello, I had a radical prostatectomy July, 2013. I've had yearly psa test done and results have been <.1, however I just one completed today and for the first time received a result of .2, I'm 61 years old. I thought I had gotten past this since 7 years has passed, then upon researching after this result, I see 10 years is the benchmark. Kinda worried, sent my results to Alan Partin, my surgeon, but he's gone for the weekend. I read somewhere .2 is the benchmark for recurrence. Bummer.

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I had radical prostatectomy July 2013 at 53 years old. Test yearly always came back <.1, today, I received result of .2 and my surgeon Alan Partin is gone for the weekend. Seems like .2 is the threshold for recurrence. I thought I was pretty safe after 7 years of <.1. 🙁 I'm 61 yo now and thought I was out of the woods… How concerned should I be and it it treatable?

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@natem

I had radical prostatectomy July 2013 at 53 years old. Test yearly always came back <.1, today, I received result of .2 and my surgeon Alan Partin is gone for the weekend. Seems like .2 is the threshold for recurrence. I thought I was pretty safe after 7 years of <.1. 🙁 I'm 61 yo now and thought I was out of the woods… How concerned should I be and it it treatable?

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No reason to hit the panic button.

You may have BCR with .2, another PSA test with a .3 or higher.

If so, you'd have done decisions to make, treat, when, with what?

Image or not? The newer scans can detect reasonably well at around .5. If so, that could inform your treatment decision.

If the clinical data supports treatment you'll have choices. A combined therapy involving radiation and ADT may be a choice, 6 months some studies say, 18 others. Radiation may include prostate bed a pelvic lymph nodes.

You may not treat too if the clinical data such as PSA doubling and velocity times which indicates aggressiveness. If PSADT is greater than 12 months you may just continue to monitor and treat later if needed.

There are other options than ADT too.

Do your homework, inform yourself, discuss with your medical team. You will have time to make a decision.

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@natem

I had radical prostatectomy July 2013 at 53 years old. Test yearly always came back <.1, today, I received result of .2 and my surgeon Alan Partin is gone for the weekend. Seems like .2 is the threshold for recurrence. I thought I was pretty safe after 7 years of <.1. 🙁 I'm 61 yo now and thought I was out of the woods… How concerned should I be and it it treatable?

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I agree with the other comment that it is no reason to panic, but you should learn the facts and work with your doctor to come to the best resolution. I had a radical prostatectomy in December of 2000 at the age of 55. My Gleason score was 7 (4+3) although there was some debate about it being 8. My psa was never less than 0.1, but was around 0.11 or 0.12 (don't think people use the more sensitive readings much any more). I thought I was done with prostate cancer, but then in 2015 it went to 0.15 and in 2016 to 0.26. There was one questionable margin from the surgery so my doctor thought the recurrence might be local. I had bone scans which showed nothing and the thinking was that the recurrence was in the prostate bed. I had 6 months of ADT starting in March of 2017 and 7 1/2 weeks of radiation which ended in October of 2017. My psa is now less than 0.1 and I had no permanent affects from the treatments and am back to not worrying about prostate cancer at 76. Hopefully this is just a small bump in the road for you like it was for me.

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My dad was diagnosed to be Prostate cancer in 2018.11 and he took the surgery right away. After that he was treated for 2 years by Gesorelin. from end of 2020 he stopped the treatment according to doctor's advice and then yesterday when he did the routine check the PSA is back to 0.11.
Wondering is it because there are bad cell not cleared during the surgery? Is it very common to have PSA back after stopping ADT?

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@jerryice

My dad was diagnosed to be Prostate cancer in 2018.11 and he took the surgery right away. After that he was treated for 2 years by Gesorelin. from end of 2020 he stopped the treatment according to doctor's advice and then yesterday when he did the routine check the PSA is back to 0.11.
Wondering is it because there are bad cell not cleared during the surgery? Is it very common to have PSA back after stopping ADT?

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Welcome Jerry, I moved your question about rising PSA levels after surgery and treatment to this existing discussion where @hoard had a similar situation. I encourage you to read through the posts in the discussion.
– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/

And this related discussion
– Detectable PSA 9 years post prostatectomy https://connect.mayoclinic.org/discussion/detectable-psa-9-years-post-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

Has your dad had a consult with his oncologist since getting his PSA reading? Will other tests be done?

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I had a Radical Retro Pubic Prostatectomy August 2021
The PSA 3 months after was 0.01. I had a routine physical in December and the lab work showed the PSA now is 0.05 a 400% increase. I messaged the surgeon at Duke Cancer Center who will do another set of labs the first part of March. I was told that 0.05 is still considered undetectable. I am concerned with the sharp rise in just a month, Should I be concerned? I also had a Decipher genetic test, that said I was intermediate risk for a reoccurrence. The only thing on the test that I saw as a red flag was the positive result for Perineural invasion, meaning that cancer was detected in the nerves within the prostate. Can anyone shed any light or guidance on this?

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