PSA detectable 18 mos after prostatectomy

I had my RALP in August of 22. I was the 4 + 3 Gleason with a PSA of 3.46 two months before surgery. Pathology of gland confirmed Gleason 7. No Perineal Invasion or EPE. Surgeon said contained. All PSA tests were less than 0.1 until 3 days ago. 0.24. My previous PSA in January of 2025 was less than 0.1. I'm so disappointed. Have meeting today with my Urologist/Surgeon.

I'm sorry to hear that.

I know it's very upsetting right now, but it's not dire: surgery sometimes (often?) doesn't get all the cancer, because there's no way to detect any individual cancer cells that might have already left the prostate but haven't built tumours big enough to show up on imaging.

If your new scans are still clear, it might just be a case of active surveillance for now. If imaging shows cancer still localised (or just a few metastases elsewhere), it might be easily treatable with radiation; you might also end up back on ADT, and maybe an ARSI (like the -lutamides), depending on what they find.

I hope the appointment goes well today. Best of luck!

Well the retest was the same. My Urologist said he was shocked by my results. I asked him to perform a Decipher test as I'm confused why my PSA increased as soon as 3 years considering I was Intermediate risk albeit unfavorable. Tumor was supposedly contained to prostate. Now back to worrying about scan results, more frequent PSA test results, etc. I know there are worse cancers but this is really depressing.

I imagine you feel gutted. Mine never went to undetectable after RP with a low of .03. BCR after 2 years with doubling every 6 months second year, followed by radiation and ADT which I am finishing up in 4 days. Best of luck and hope you are going to a research hospital instead of a private practice. One uses standard of care which translates to safe for the doctor and the other cutting edge with SOC and stage 3 drug trials looking a cure. I'm surprised they aren't proposing a PSMA and suggesting ADT and radiation. .2 was my providers trigger point. Research hospital Genitourinary doc suggested waiting until 2.0 and stated they could find it and treat it at that point. That will gin up some controversy in the room. Best wishes for you with these challenging decisions that you have to make.

I'm getting an authorization code today for the PSMA. Have an appointment in 2 weeks with head of Oncology. My Urologist/surgeon said I'll probably get 28 sessions of SRT with possible ADT, but Oncologist will make the final recommendations. I hope your radiation and ADT is going well. How many sessions of radiation and how long on ADT did they suggest for you?

I did 25 sessions of radiation and 6 mos of ADT. Pro tip from my experience. If you have never had radiation I would suggest asking for SpacOre gel to protect your rectum and Oxybutynin for bladder urgency up front once you are ready to pull the trigger on your treatment. My bladder urgency was so bad after 3 weeks that I blew up on the table twice in one session. I only got the drug after telling them I wouldn't get back on the table until they gave me something for it. They really want that 5K per session and it was at my pharmacy the next morning. I hate private practice. I hard quit my RO this week when they called to confirm my 3 month follow up.

You're right, it is depressing at first. For the first year after my metastatic cancer diagnosis, I was convinced my life was nearing its end, and tormented myself by thinking of all the things I was going to miss out on (I was only in my mid 50s at the time).

But eventually, when the sky didn't fall, I got used to living with "incurable" cancer, and grateful for the new medicines and treatments that are keeping it in check. On average, I'm probably happier now than I was before my diagnosis, strange as that might sound.

Thanks for the tip.

I find this video and presentation excellent. This approach completely make sense to me ( IMHO).

Hey Perry, your situation, unfortunately, is all too common. You can get all the boxes checked off and still come up with a recurrence - I did too…
Mine took 5 yrs (Gleason 4+3 unfavorable) to recur; I did 25 tx IMRT with 6 mos ADT. Not bad at all. Diet, exercise and some SE’s were bothersome but totally do-able.
I just want to add to what chippy said about rectal spacer. I, too, wanted one but my RO said no because of the possibility of cancer cells near the rectum - he did not want the beams blocked by the spacer.
I know right now you are depressed and disgusted but please focus on the fact that this is your second chance to beat this. If you had radiation first (which many men have), you’d be facing a lot of ADT for a much longer time, possible doublet therapy, and risky salvage surgery as a last resort.
Also, be SURE to have your pelvic nodes irradiated as well - look up SPORTT trial for more info - not just the prostate bed.
Best,
Phil