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.

@dpybarra

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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Welcome @dpybarra, you'll notice that I moved your message to this existing discussion where @hoard was asking the same questions. I encourage you to read through the sage advice from fellow members
– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/

As you likely know, the PSA test alone is not enough to determine cause or next steps. Your doctor will likely order additional tests or followup in a few months with another PSA test. Do you have a followup appointment schedule with your oncologist?

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@colleenyoung

Welcome @dpybarra, you'll notice that I moved your message to this existing discussion where @hoard was asking the same questions. I encourage you to read through the sage advice from fellow members
– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/

As you likely know, the PSA test alone is not enough to determine cause or next steps. Your doctor will likely order additional tests or followup in a few months with another PSA test. Do you have a followup appointment schedule with your oncologist?

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Yes in the first week of March, this will be the second 3 month labs and follow up.

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I have been Cancer free since my surgery removal of Prostate in July 2019. I have maintained <0.1 and as low as <0.02. still at this as of Jan 25,2022. I had a VA physical, and they do an ultra-sensitive PSA test Test Before in Dec 2020 was 0.008 this recent test is 0.016. Do PSA levels go up and down? I do not think Cancer is back My Path was very good from Surgery. No SV, Lym node Invasion Clear Margins, contained to the Prostate and Capsule. should I be alarmed!!

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@fmcallister1954

I have been Cancer free since my surgery removal of Prostate in July 2019. I have maintained <0.1 and as low as <0.02. still at this as of Jan 25,2022. I had a VA physical, and they do an ultra-sensitive PSA test Test Before in Dec 2020 was 0.008 this recent test is 0.016. Do PSA levels go up and down? I do not think Cancer is back My Path was very good from Surgery. No SV, Lym node Invasion Clear Margins, contained to the Prostate and Capsule. should I be alarmed!!

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Hello, @fmcallister1954 Yes, it's scary when tests come back with a slightly higher PSA and I understand your alarm. My brother is being followed for prostate cancer (prostatectomy in 2020) and we've had many discussions about his treatment and what the PSA levels mean. I've been treated for uterine cancer and I also know how frightening it is to get back results that you did not expect. While you'd hope that the PSA number is exact and reliable there are many reasons why the number can change. This link from the American Cancer Society explains the fluctuations:
https://www.cancer.org/cancer/prostate-cancer/treating/psa-levels-after-treatment.html
Are you being followed by an oncologist or the surgeon at the VA? How often do get a PSA? You mention a PSA test done in December 2020. And this new test is a year later. If you were my brother, I'd tell him to call the doctor who is following him and ask about this new PSA result. I would want to know the plan – should the PSA be repeated in 3 or 4 months to see if it changes?

Would you please come back here and let me know what you find out from your doctor?

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@fmcallister1954

I have been Cancer free since my surgery removal of Prostate in July 2019. I have maintained <0.1 and as low as <0.02. still at this as of Jan 25,2022. I had a VA physical, and they do an ultra-sensitive PSA test Test Before in Dec 2020 was 0.008 this recent test is 0.016. Do PSA levels go up and down? I do not think Cancer is back My Path was very good from Surgery. No SV, Lym node Invasion Clear Margins, contained to the Prostate and Capsule. should I be alarmed!!

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No Oncologist is involved yet!! Contacted my Urologist and told him, has not responded yet, I am still considered < 0.02 very low. @ 0.016 that only 16 above 0.000 or none at all so it is very early yet. I will no doubt get rechecked in 3months.

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@fmcallister1954

No Oncologist is involved yet!! Contacted my Urologist and told him, has not responded yet, I am still considered < 0.02 very low. @ 0.016 that only 16 above 0.000 or none at all so it is very early yet. I will no doubt get rechecked in 3months.

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Fmcallister, your question about whether you should be alarmed at rising PSA levels after prostatectomy is commonly asked in the forum. For that reason, I have moved your question to this discussion:

– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/

I strongly encourage you to read through the discussion to see the helpful advice from fellow prostate cancer members. The short answer is "No, you should not be alarmed. But yes, it should be noted by your team and discussed."

Has your urologist been in touch? What did you learn?

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Radical open prostatectomy 10 years ago. Levels and risings low for years. Recently, readings went from 0.13 in May of 2021 to 0.28 in February 2022. Is that much increase in 9 months reason for concern ?

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@3185

Radical open prostatectomy 10 years ago. Levels and risings low for years. Recently, readings went from 0.13 in May of 2021 to 0.28 in February 2022. Is that much increase in 9 months reason for concern ?

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3185 Have you consulted an Oncologist ?

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@3185

Radical open prostatectomy 10 years ago. Levels and risings low for years. Recently, readings went from 0.13 in May of 2021 to 0.28 in February 2022. Is that much increase in 9 months reason for concern ?

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Hi @3185, I assume you got some of your answer in the responses in this discussion. As many have reported there can be a variety of reasons for rising and falling PSA values. While PSA is a useful indicator, it must be coupled with other diagnostics if there is reason for concern. Only your oncologist can determine whether your increase from 0.13 to 0.28 over 9 months warrants further investigation. Have you discussed this change with your oncologist?

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