Post RALP PSA - how concerned should I be?

I don't know what that means but I'm nearly identical with your data points so I'm curious as to what might be going on in case I run into this in a years time (just completed prostatectomy, age 54, Gleason 3+4, Decipher .7, path clear margins and no seminal invasion and clean lymph nodes).

I'm enjoying the fact that I'm not worse off but know, based a lot on what I've read here, that I might be in for a second bout with this demon in 1-3 years.

My situation is somewhat similar. However, cancer was found in one of eight lymph nodes. I’ve been having my PSA checked every three months for the past three years. It’s at .13. The good news is it hasn’t changed, and I’ve avoided radiation and ADT shots. I feel great and happy for each new day.
My suggestion for you, relax your doing well!

All you can do is keep testing and see where it goes. It took me 5 yrs to need more treatment, others more than that.
Don’t stress! What will be will be.

I'd let your Doc make the call on any need for future treatment
You're still at a low PSA and the Doc will know when it's time to think about so called salvage radiation therapy. There's lots being published on that lately where they say it's better to initiate it sooner than later. Good luck!

My post RARP was less than .05 for quite a while. Then it moved to .08 three months later to .12, then to .18. My urologist said once the PSA went over .20 they could find the cancer with a PET Scan. My next PSA was at .25 and ultimately the tumor was found in the bed area where the prostate had been. I had an MRI in November, 2024 to help pinpoint the location and started on Bicalutimide on December 1st and my first Lupron shot on Dec. 6th. I have a CAT Scan on February 20th for final radiation parameters. I will then start 8 weeks of radiation, five days a week at the Buffett Cancer Center in Omaha. My original score was 4+3. After the pathology of my prostate I was graded Stage 3 as the cancer had broken through the prostate capsule. The urologist had removed some local lymph nodes but didn't get all the elusive little cells!

My husband 58yr is post RALP this July. Gleason 4+3=7 with adenocarcinoma spread to unclear margins of two out of 22 surrounding lymph nodes. He is classified as having Stage 4a cancer because of the lymph node involvement. Northwestern Medicine in IL is saying he needs 37 Photon VMAT - IMRT treatments with daily CBCT five days a week using an Inverse Treatment Plan along with Hormone Blockers/Therapy. He is 58 years young. I am crushed. Anybody else go through this or have comments to share? His first post op PSA came back at undetectable so that’s good. The oncologist are saying because he has lymph node involvement with UnClear Margins they want to move sooner than normal (start at 3 months post RALP instead of 4-6 months). They said this will give him a 71% chance of beating the cancer verses a 20% chance without the treatment.

An error

The treatment options you have been given are quite normal for the prostate cancer reoccurrence your husband has had. The hormone therapy they are recommending will stop the cancer from growing and actually shrink it in most cases. That way, the radiation is more successful.

The sooner they do the radiation treatment the better. The surgery was not completely successful since the margins were not clear. They are using the appropriate medical procedures To extend your husband’s progression free survival.

After my surgery, at 62, my margins were clear, but it still came back after 3 1/2 years. At that time I had 7+ weeks of radiation.

There usually is no cure once you’ve had a reoccurrence of prostate cancer outside the prostate. Treating it properly can give you long-term remission, But it frequently comes back if hormone treatment is not continued for an appropriate amount of time. Even then, it’s probably in his bloodstream so it’s going to be around for life.

After radiation, there’s a good chance your husband will have a long time before reoccurrence. It was 2 1/2 years after my radiation before it came back, But for me it’s been treatable with hormone therapy and ARSI Drugs for nine years after that.

Prostate cancer treatment has improved greatly in the last few years. I started off with surgery 15 years ago and I’m still alive anfter 4 reoccurrences. People I know have no idea I have prostate cancer, Unless I tell them. The latest drugs work really well and there’s more new treatments coming out all the time.

Thank you for your response and sharing. During your radiation treatment can you tell me what your side effects were, how to prepare, was working a full time job during treatment feasible, and what did you find was the most helpful from others? I appreciate any helpful feedback.

I had Salvage radiation for 7+ weeks. I had no side effects at all. I was running a computer consulting company and went to clients offices right after the morning radiation.

I was 65 at the time, It can be harder on older people.

Some of the people coming out from radiation had fatigue or urinary issues, it just never bothered me. They did work for 2 1/2 years.