PSA after surgery

Probably want to get another PSA to confirm no lab error. PSA should be close to zero after RP. If it is 1 that indicates prostate cancer outside the area removed. Did surgery report indicate positive margins? Might need PSMA PET to check for distant metastases. Cialis 5mg daily usually given for blood flow since that has a half life of 24+ hours. Viagra is about 1/4 of that. Other than some instruction trimix/bimix medication is self-injected. Lots of comments on this site about Trimix. Read them. Nothing was exposed when I went through RT except for CT/MRI imaging.

After a prostatectomy, your PSA should hit undetectable (below .1). If it doesn’t, that means, you have a metastasis somewhere that is putting out PSA. The normal technique to resolve this is to do salvage radiation. They usually don’t want to do that until about nine months after the surgery.

Hormone therapy is pretty much essential when somebody has a prostatectomy and their PSA has not hit undetectable. Hormone therapy will stop the cancer from growing any further while you wait to have radiation. It can suppress growth and prevents spread. That’s why you want to do it when your surgery is not successful..

There’s lots of people in this group that have used injections into their penis to get erection. The most common ingredients are called Trimix. If you were to go to the top level of the prostate cancer group, there’s a search bar and you could put in Trimix and search for other people’s comments.

Here’s a really good discussion of using Trimix
https://connect.mayoclinic.org/discussion/my-trimix-experience/
Who’s with the American Society of clinical oncology has to say about what to do when your PSA does not become undetectable after a prostatectomy.

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/

I waited 3 months after RP to have my PSA tested (.087). I was told that your body needed time to recover and the PSA in your blood to "thin out" once the prostate was removed. So, 6 weeks seems a little soon. Like was previously mentioned, have a follow-up blood test for PSA after another 6 weeks. I would not start radiation quite yet. Good luck

@gfeaglefan "I waited 3 months after RP to have my PSA tested (.087). I was told that your body needed time to recover and the PSA in your blood to "thin out" once the prostate was removed. So, 6 weeks seems a little soon. "

That's what I was told as well, to wait 3 months.

As someone already mentioned, to evaluate that single psa reading it would be informative to know your pathology and Decipher. You should also ask for a psma to see if, if confirmed, the spread is just local.

You should probably see an ED specialist. The standard protocol is 5mg Cialis each day and 20mg (a full dose) twice a week. Do not expect results quickly. The important thing is to avoid your penile myscles to atrophy. Recovery is a function of nerve healing, which can take time. You should also start using a penile pump.

Injections are used for both, intercourse and keeping bloodflow active. In my expetience they are finicky. I have not tet encountered the right mixture dose. Either no effect or one that last way too long…

@topf thank you for the advice. I appreciate it greatly.

@readandlearn yeah the Dr ordered a PSA test on the day I saw her. But I trust she knows what she is doing. My level was over 18 before surgery.

Following a prostatectomy, they typically wait 3 - 4 months until the first PSA test to allow time for PSA remnants to fully leave the bloodstream. After that, PSA should always remain (at least nearly) undetectable.

At just 7 weeks post-surgery, a PSA of 1.0 is not unusual and indicates the likelihood of remnants of PSA still in your blood. (Your urologist should be aware of this.)

If you wait a couple of more months, and repeat the PSA test, you’ll likely find that your numbers are good. At the very least you’ll know that you’ve given it an appropriate amount of time.

Hold off on the radiation+hormone therapy discussion until after that 3+month PSA test.

As for what to do about the ED, here’s a 2023 presentation out of Stanford University that’s titled “Penile Rehab: Optimizing Recovery of Erectile Function after Prostate Cancer Treatment.” They talk about things to do before and after surgery to help with ED issues: https://youtu.be/aRp1NXjPGLE

Simply because numbers can strengthen a point of view and maybe make you feel better about your PSA, I’ll add that I’m another one who was told by my care team to wait three months before checking PSA (I was undetectable at that point).

With the ED, I have no experience with shots (and never expect to, frankly), but I’m on a nightly half-dose of Viagra, along with a weekly full dose (coupled with trying to achieve an erection), and a penis pump to boot. The pump isn’t just to get an erection for sexual performance (along with a constrictor band), but to help regain/maintain penis length/girth and combat potential scar tissue formation, and to generally keep the tissue down there healthy during the long road to recovery.

I’m a little less than 10 months from surgery, no luck on gaining an erection, but I’m seeing improved blood flow during arousal (blood flows in, penis grows, but my body’s natural “clamping” mechanism doesn’t work yet, so no stiffness yet).

@brianjarvis wrote "At just 7 weeks post-surgery, a PSA of 1.0 is not unusual and indicates the likelihood of remnants of PSA still in your blood."

I don't believe this is accurate. But I'd be happy to be corrected if you have sources that support a different interpretation.

All the sources I've seen put the half-life of PSA after radical prostatectomy at approximately 2 to 3 days. (Example: https://www.urotoday.com/conference-highlights/apccc-2026/168594-apccc-2026-psa-persistence-or-recurrence-after-radical-prostatectomy-when-and-how-to-react.html notes that "the total PSA half-life is 2.7-3.3 days" and defines persistence as a PSA of >0.1 at 6 weeks post-RP.)

With a pre-op PSA of ~18, @djkurr 's PSA should have dropped below 1 after about 5 half-lives, or roughly 10-15 days. By 6 weeks after surgery, his PSA should be undetectable if all the cancer were removed.

I'm not trying to be alarmist, but the facts presented suggest either lab error in that 1.0 result (or a misunderstanding by djkurr) or persistence, which would warrant attention by the oncologist. It's misleading to suggest that a PSA of 1.0 six weeks after RP is in any way normal here.

@djkurr , did you have a PSMA PET scan prior to surgery? Were any lymph nodes removed and examined? It would also be helpful to know what your post-op pathology report said.

But you should start reading up on adjuvant radiotherapy+ADT and be prepared to discuss with your oncologist whether that would be appropriate for you. It's not indicated for men who have low or undetectable PSA after surgery, but can yield life-saving outcomes in cases of persistence when extra-prostatic cancer was missed.