Rising PSA 2 years after radical prostatectomy

Posted by olanordman @olanordman, Feb 22 1:10pm

I am 60 years and I had radical prostatectomy on 23rd Nov 2018. I was told out of the 15 lymph nodes taken only one was affected less than a millimetre. It was Gleason score 7B with PSA around 13 at time of surgery but 11 at time of diagnosis in June 2018.
The PSA been fluctuating between 0.09 and 0.18 since surgery on 23rd November 2018
I have no incontinence as well as Erectile dysfunction. I take hypertension medication – Norvask Amlodipine 5mg daily and Cetirizine 5mg for allergy. Below are some of the test results. I have many of these test results – a few below
Jan 2019: 0.11
April 2019: 0.11
June 2019: 0.09
August 2019: 0.12
December 2019: 0.12
April 2020: 0.12
August 2020: 0.11
October 2020: 0.17
December 2020: 0.15
February 2021: 0.18
I am worried the cancer may be returning or might have spread. I met my doctor today and expressed my concerns. He has agreed to refer me to the hospital where I had the surgery. Any suggestions based on this brief history?

@olanordman Where are you, are you in the US? Getting a second opinion is always a good idea.

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I am in Norway. Thanks

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Sometimes the instrument used to measure the PSA may cause some fluctuation between two different devices. I am not sure if the devices require calibration on a regular basis. However, not a reason to let your guard down.

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@olanordman, you may also wish to read these related discussions:
– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/
– High PSA three years post op https://connect.mayoclinic.org/discussion/high-psa-three-years-post-op/
– PSA numbers: Questions about new treatments https://connect.mayoclinic.org/discussion/psa-numbers/
– Follow up after proton beam treatment: GREAT PSA NUMBER https://connect.mayoclinic.org/discussion/great-psa-number/

You ask a good question. What can rising PSA levels means years after having had a prostatectomy?
There are several reasons why one's PSA level may rise after being stable for a time. This article explains it well:
– PSA levels after prostatectomy https://www.medicalnewstoday.com/articles/323899.php

Here's an excerpt from the article:
"Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.

In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include:
– older age
– ethnicity
– medication
A doctor will take these factors and the person's medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern."

The PSA test alone is not enough to determine cause or next steps. Your oncology team will consult with you and likely order other tests. Did you have other treatments after surgery?

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@colleenyoung

@olanordman, you may also wish to read these related discussions:
– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/
– High PSA three years post op https://connect.mayoclinic.org/discussion/high-psa-three-years-post-op/
– PSA numbers: Questions about new treatments https://connect.mayoclinic.org/discussion/psa-numbers/
– Follow up after proton beam treatment: GREAT PSA NUMBER https://connect.mayoclinic.org/discussion/great-psa-number/

You ask a good question. What can rising PSA levels means years after having had a prostatectomy?
There are several reasons why one's PSA level may rise after being stable for a time. This article explains it well:
– PSA levels after prostatectomy https://www.medicalnewstoday.com/articles/323899.php

Here's an excerpt from the article:
"Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.

In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include:
– older age
– ethnicity
– medication
A doctor will take these factors and the person's medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern."

The PSA test alone is not enough to determine cause or next steps. Your oncology team will consult with you and likely order other tests. Did you have other treatments after surgery?

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Hello. Thanks for your input. I just came across this information on a sheet after my surgery to remove the postrate. I had to go to an online portal to get this information

It states STAGE pT2pN1a. What does this really mean?

8 lympth node taken from left. only 1 lympth node showed 1mm long micrometasis with Gleason grade 3

6 lympth nodes taken from right no any metasiss

This is written in Norwegian but I tried to interprete it.

Yet to get an appointment as I was referred to a radiologist to assess if I need radiation. My PSA is 0.18. I am booking an appoint for another test

12.12.2019 0.12
17.04.2020 0.12
21.08.2020 0.11
22.10.2020 0.17
22.12.2020 0.15
22.02.2021 0.18

Regards

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I am wondering if one has to avoid riding bicycle, refraining sex for at least 48 hrs before going for a PSA test even if ones postrate has been removed surgically. I dawned on me that some time I go for my PSA check either a day or less after riding a bicycle or or having had sex. Just read an article which states men should refrain from having sex a nr of days before a PSA test. I had my radical prostatectomy in 2018

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I had rp 4/18. 2 1/2 years undetectable psa. 12/20 psa at .15. Now at .28. Pre rp psa 4.51. Gleason 7 4/3 some lymph node involvement. Recommendations?

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Hello. I am almost in your situation. I had mine on 23rd Nov 2018. Below are a few results.

Jan 2019: 0.11
April 2019: 0.11
June 2019: 0.09
August 2019: 0.12
December 2019: 0.12
April 2020: 0.12
August 2020: 0.11
October 2020: 0.17
December 2020: 0.15
February 10th 2021: 0.18
MARCH 24th 2021: 0.13

I became very alarmed when it shot up to 0.18 and my doctor referred me back to the urologist who explained that they can see some ACTIVITY because of the rise and fall. He then referred me to a radiologist who has requested PSMA PET/CT scan. I am due for it on 7th April.
I will suggest that you contact your urologist may be for a PSMA PET/CT scan. I do not know what pertains in your country but here I am paying 31USD for the PET scan. In Norway we are all covered with a national insurance.

Before the last scan I stopped some medications – allopurinol and crestor as I was told that the former can raise psa level and the latter can reduce the level thus giving false values. No sexual activity for 3 days before I went for the text. I am not sure these might have contributed to the sharp decline.

I was also advised a high psa level does not necessarily mean prostate cancer has returned as they could be normal cancer cells. However, I do not want taking chances, so I monitored my psa every 3 months instead of the 6 months that was recommended.

I wish you the best.

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Thanks. Great info. Surprised they want a pet scan at ur <.2 psa. Consulting on 4/5. Pls let me know how ur pet scan turns out

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@itterac

Thanks. Great info. Surprised they want a pet scan at ur <.2 psa. Consulting on 4/5. Pls let me know how ur pet scan turns out

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Will update you when I get the results

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@olanordman

Hello. I am almost in your situation. I had mine on 23rd Nov 2018. Below are a few results.

Jan 2019: 0.11
April 2019: 0.11
June 2019: 0.09
August 2019: 0.12
December 2019: 0.12
April 2020: 0.12
August 2020: 0.11
October 2020: 0.17
December 2020: 0.15
February 10th 2021: 0.18
MARCH 24th 2021: 0.13

I became very alarmed when it shot up to 0.18 and my doctor referred me back to the urologist who explained that they can see some ACTIVITY because of the rise and fall. He then referred me to a radiologist who has requested PSMA PET/CT scan. I am due for it on 7th April.
I will suggest that you contact your urologist may be for a PSMA PET/CT scan. I do not know what pertains in your country but here I am paying 31USD for the PET scan. In Norway we are all covered with a national insurance.

Before the last scan I stopped some medications – allopurinol and crestor as I was told that the former can raise psa level and the latter can reduce the level thus giving false values. No sexual activity for 3 days before I went for the text. I am not sure these might have contributed to the sharp decline.

I was also advised a high psa level does not necessarily mean prostate cancer has returned as they could be normal cancer cells. However, I do not want taking chances, so I monitored my psa every 3 months instead of the 6 months that was recommended.

I wish you the best.

Jump to this post

My PSA has been around .3 for 2years I monitor by taking my PSA every 6 weeks and a 3T MRI once a year which is the least intrusive and produces excellent image results beats biopsy all to hell. Anyway I was told not to take a PET Scan because it would produce false positives. Anyone else encounter such statements from your Dr.?

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Good information. Have you had radical prostatectomy – postrate removed? I thought without a prostate the bench marck was 0.2 for salvage treatment.

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