PSA level 7 weeks post radical prostatectomy: Thoughts?

< .1 is considered undetectable. My PSA has been at that point for 16 months now (after 15 years and 4 reoccurrences), You never know when it’s going to go up.

If your PSA does rise to .2 they usually do salvage radiation? With a Gleason nine it is not unusual to see a reoccurrence.

Working with a GU oncologist at this point really is important. They should be guiding your treatment from now on. There’s nothing more the surgeon/urologist can do besides prescribe drugs, The next step would be the radiation oncologist, which the urologist would usually send you to.

Prefacing the fact that nobody here is qualified to tell you what your next steps should be, the entire point of having the PSA checked every few months for the first couple of years is to check for anomalies or metastasis. You had your RARP the day before I had mine, my first post-op PSA came in at 0.07, with my urologist saying the 0.2 is where things get amped up - for me, it could be that a lower PSA causes concern for your urologist given that I was Gleason 7 versus your 9.

As an example of why I prefaced that comment: I've read on here numerous times that 0.1 was the threshold for more treatments, but in reality it's 0.2. Perhaps it was increased and some folks are still referencing the 0.1, but when I got my 0.07 I was a bit concerned that I was on the bubble and the slightest bump would put me into radiation - mostly based on reading that statement here. It turns out I was concerned about nothing, my urologist literally said "excellent" on his notes regarding the PSA test result.

Gleason9, Grade 5 with EPE and not ONE lymph node was checked?? Sorry, that doesn’t make sense to me. You are a high risk case and at least the proximal node closest to the gland should have been sent to pathology. That’s what my surgeon did and I am still pissed about it, since most good surgeons take 6 or more on each side - especially for a high Gleason score.
Phil

Hmish:

My sense is that only time will tell.

My 1st postop PSA was at the 3 mos point and "persistent" at .19, leading me to the Radiation Oncologist for Salvage Treatment. Which so far (18 mos) has worked wonderfully.

My post op pathology was G 9 w/ EPE (and all else clear).

You may continue to be undetectable at 90 days and beyond; or there might be BCR months or years in the future. Or never?

I would continue 3 mo PSA testing and respond accordingly.

Best wishes.

Phil
Thanks. The reason I am told that he did not check the lymph nodes is that I had bilateral laparoscopic inguinal hernia surgery and umbilical hernia surgery 3 months prior to my surgery and they felt that it was too dangerous to sample a node, including the proximal node due to the mesh in my abdomen. I agree with you that they should have been able to at least sample one or more. I am thankful that the PSA was < 1.0 but I am concerned and feel as if my surgeon does not think it was necessary. I plan to see a GU oncologist ASAP as I am worried.

Thanks Michael. I am still fighting to regain my continence so I will work on getting "dry", which in and of itself is a real quality of life bummer. I am doing my Kegels but still do not see a light at the end of the tunnel. I appreciate your response as you, and I had a similar post op path. I hope your journey to continence was a lot smoother than mine has been.

Stay well

Your hernia predicament sounds awfully familiar - did the forum discuss this already or was it another member’s case?
I think at the time a few of us recommended going on ADT to arrest the cancer and then do surgery in 3 months?
In any event your concern is certainly warranted. Less than .10 is considered “undetectable” but < .01 would be even better after surgery, right?
As others have suggested, you really don’t know for certain that all the cancer was NOT removed, but it’s a real fear. But if any was in the nodes or bed I would think a G9 (Decipher Score?) would express higher PSA sooner rather than later and any significant rise over your initial value would indicate probable cancer cells; then it would be ADT and salvage radiation. However, That’s not the worst thing - THE WAITING IS. It’s death by a thousand cuts and I swear 5 yrs of that almost did me in….
After going thru those anxious, uncertain times all I can recommend is plan for the worst (which isn’t so bad really), and hope for the best - that’s what it comes down to.
Phil

@survivor5280
Right on. Great post!

Just had a psa test at mayo Rochester last week and had .1 called undect able. My local labs call me .01 undetectable. A previous poster made reference to different labs using expressing it differently. Don t worry, test psa frequently and watch for upward movement.

@billfarm
Great news for you. Can't ask for anything better than undetectable PSA tests.

I have mine done at Mayo every 3 months. The last one I had was .22 but was happy with that as when I was diagnosed with prostate cancer it was 3.75. I know that is still normal but for about 3 years my PSA test was rising every time tested. I have a great PCP at Mayo, and he did not like the rising numbers and thus referral to a urologist.

I will be at my 2 years after treatments ended July 2025.