Post surgery PSA after 3 months was 1.77

@josephtj
Again, I really suspect this doctor is not giving you the best treatment possible. One other person mentioned they had salvage radiation at three months. I know other people had the same thing..

Have you had a PSMA pet scan? That is essential to be done before radiation before ADT and immediately actually. The doctor should not be waiting. They should be doing this right now. It is very likely you have a metastasis that can be visibly seen since your PSA is so high. That might enable you to not have salvage radiation since it’s already pretty late. If you were to go to a center of excellence, they would immediately have you do this scan. It’s essential to be done before radiation because the metastasis may not be where they radiate.

Another thing you should be aware of is that the medical group that sets the standards for treatment says that if your PSA is above .5 you should be on ADT. Has your doctor told you about that?

Here is some information from that group about when you should Have salvage radiation after surgery. As you can see, you are way beyond the high level PSA that it is recommended to be done. This is another thing you should bring up with your doctor along with the need for the PET scan.

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

Thank you so much.

Not the outcome you were looking for. I get it as my post surgery PSA never went below .03 for 6 months then .04 for 6 months, then .08 after 18 months then .22 at 2 years. PSMA was clear then Radiation and ADT followed. Sometime a second opinion is helpful with a fresh set of eyes. I would suggest an NCCN facility with GU oncologists. Not sure who you are being seen by. If I go BCR again I will go the facility that I had my second opinion with. My Current doctor is an surgical oncologist with an interested in oncology per his bio. If I have another reoccurrence I will be in front of a GU Oncology. No more patience for doctors that want to merely practice on me. Best wishes on your journey.

@chippydoo , Like others said, you should get at least one second opinion if not two from a center of excellence like Sloan Kettering, Mayo, MD Anderson and others of the same quality.
I did after I was diagnosed with PC. You're not going to hurt your doctors' feelings feeling's by doing so and if they get upset, then they aren't the doctors you need. I told my doctors I got a couple of second opinions and where I went and they were happy I did that.
You only have one life, and you need to fight as hard as you can to get the best outcome as you possible can.
This group of people in this forum are an absolutely a great source of information, but in the end, it's between you and your doctors. Best of luck and Happy New year!!

I'm a little confused by "GS 24...!?"

GS is a 6-10...

If you had surgery, you have a pathology report, that tells this group a lot.

Regardless, a PSA like that is indicative of necessitating a treatment decision.

The question is when, what, for how long?

You have some of the clinical data to make that decision in concert with your medical team.

Other data that may be useful...

Data from PSMA PET
Decipher score from the prostate tissue
Genetic testing.

Likely you doublet or triplet therapy...
ADT + ARI
ADT +ARI + chemotherapy

Radiation may be in play, depends on the imaging results.

You may be looking at 24-36 months of systemic therapy. The surgery may be curative in its attempts but given its failure, you are likely looking at advanced PCa and may be in for lifelong management through treatment.

Which agent, which ARI, do you add chemotherapy, can radiation be used...those are questions you and your medical team should discuss.

This group can give you our experience, lessons learned and corporate knowledge gained through the school of hard knocks. We know the difference between say Lupron vs Orgovyx, Nubequa vs say Xtandi,, what the guidelines such as NCCN and AUA say as well as results from clinical trials entering mainstream clinical practice.

From what you describe about your current medical team, I am underwhelmed with what they have to say.

For example, the next treatment is radiation...not necessarily, doublet and triplet therapy are in play.

Not ordering a PSMA PET is another red flag to me. Either they are behind the power curve in knowledge or worse, delivering perfunctory care.

Same for the decipher test and genetic testing....

I could go on but you get the idea.

Of course, to hold your medical team accountable you have to do the homework.

There are organizations which are solid and have a wealth of patient centered resources to get you up to speed.

If anything I've said to you in my response is "news to you" then you definitely have homework to do. Learn the language, know the terms, their definitions, know stages, groups, terms such as ADT, ARI, PFS, RPFS, OS....

Here are two institutions to get you started, others may chime in with ones they have used.

Prostate Cancer Research Institute

Prostate Cancer Foundation.

Kevin