Rising PSA years after radical prostatectomy

Posted by olanordman @olanordman, Feb 22, 2021

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?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Same thing happened to me once it reached 0.2 they should give you a PSMA Pet to rule out spread and set you up for salvage radiation, your PSA is still low like mine was and get another chance to kill this disease good luck

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@q95oldies

Dr. was concerned with a .22??

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Yes, .22 is concerning. My PSA was .24 and repeated 3 wks later, again, .24. I had a prostatectomy in 2014 and met criteria for BCR. PSMA PET Scan was neg. I had 37 radiation treatments to prostate bed. PSA 3 months after, 0.02, 6 months after 0.02. Another one next week.

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It would be useful if you provided an update as it would appear that your PSA, post RP is approaching .200 which is the generally agreed definition of BCR (biochemical recurrence) which indicates that further treatment needs to be undertaken.

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Those are very low PSA values and while post-surgery ideally you would want to see zero, the time series provided shows that the PSA isn't increasing much. The data listed stops in 2021, but I'll presume for input-sake that it is still in the 0.1 to 0.2 range.

Some of the webinars on BCR and imaging indicate that on occasion that specific tests will be delayed until you hit a minimum values, such as waiting until the PSA is 2.0 for performing a PSMA scan. As for me, my PSA skyrocketed from 9 to 19 in 3 months and so we did imaging, but the basis for the imaging was the more elevated PSA.

Time is on your side, it is rare for PCA to wake-up and kill on the same day, keep doing your homework and feel good about being prepared.

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Ask for PSMA pylarify. It has specific attachment in the lymph nodes.
wishing you well

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@scottyrussell

I had my prostate removed in 2015. For 7 plus years my PSA remained at < .01 then it started to head north. The first test came in at .01, then to .5 then to 1, then to 1.31 and finally to 1.61. The VA doctor tried to tell me early on that the rise in my PSA was perhaps an anomaly! The cancer was spreading and I was told that I have an aggressive recurrent prostate cancer. From late August through October I received 39 external beam radiation treatments and the Lupron shot. The side effects of the anti-hormone shot along with the radiation has left me sick. Now I’m on an every three month blood test for PSA and testosterone levels. If my levels increase together I have to decide if I take the anti-hormone shot the rest of my life or wait until cancer lands someplace and fight at that time? Decisions!

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Dear Scottyrussell,
There are many relatively new FDA approved drugs available for treating recurrent PCa. According to the Johns Hopkins' website on Chemotherapy for Prostate Cancer, after starting the drug docetaxel, "many men experience improvements in disease-related symptoms, including pain, fatigue and loss of energy." I'm not a urologist or oncologist, but as a PCa survivor (8 years recurrence-free, post-prostatectomy), I have followed the progress in diagnosis, treatment and symptom management for many years. The good news is that much progress has been made in all these areas and it can be difficult for some PCa specialists to keep up. Good luck and seek more than one opinion on the best treatment plan, especially at a medical center of excellence in treating prostate cancer.

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I had a radical prostatectomy in 2008 with negative margins. My PSA initially was undetectable but started to increase very slowly. By 2023, it was 0.2-the threshold for a recurrence. After much discussion and debate, I decided on hormones and 37 radiation treatments. One difference: instead of Lupron or other injected hormones, I took Orgovyx which is a once a day pill. I encourage men to ask about it because there are several advantages over the other hormones : no injection, faster decrease in testosterone , faster return of testosterone when you quit, fewer heart toxicities, and, unlike Lupron, etc., you can always stop taking it if the side effects are a problem. I experienced some occasional hot flashes but overall found it pretty benign. It can be expensive but I’m aware of no other disadvantages over Lupron, etc. It’s really worth asking about!

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@scottyrussell

Hey Edmund 1971 thanks for the reply. My Urologist and Radiation Oncologist both believe that my recurrent cancer is in the prostate bed and surrounding lymph nodes. I’m only a month removed from the cessation of the radiation. My guts are all messed up, I go from constipation to diarrhea constantly. The majority of the time it’s diarrhea. My last shot of the Lupron was on June 30 and I and my Urologist have decided to stop the ADT right now and see how the PSA and Testosterone do. In the meantime as I mentioned earlier I will continue to have tests every three months.
I’m 70 years old, in great shape with no comorbidities. I had a heart attack in 2019 and had to have my Cardiologist clear me for the first Lupron shot.

Thanks again, I continue to fight this crap every day and refuse to stop

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Scottyrussell:
I had similar radiation to the whole prostate bed and pelvic lymph nodes together with 4 mos ADT (Orgovyx) Feb - June.
And I had very difficult radiation proctitis, possibly related to the balloon insertion that was necessary in my case.
Radiation side effects dissipated about 4 weeks after radiation completed, and additional ADT side effects 95% gone 4 mos after ending ADT.
Hope you are improving/recovering and continue to do so.

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Hello Scotty,
I am 69 years old and had my “RALP” performed on 10/25/22.
My PSA has thankfully remained at < 0.014 since the day after my surgery through to this week.
I know that the possibility of BCR is something that every PC Patient needs to be aware of and realize might happen down the road at some point.
Unfortunately, once you have cancer you’re either in remission or you’re not for the rest of your life.
I hope I don’t have to deal with it but if I do, I will address all the related issues and facts at that time and proceed as I see fit along with my team of physicians and specialists.
So…..I can’t give you any experiential advice or suggestions other than to educate yourself as much as possible on the subject. More “Knowledge” can produce more power in almost any situation.
As you know, when it comes to PC, it’s a condition that one needs to monitor closely and consistently for the rest of their life.
As almost every patient is different to a degree in a number of areas, the “No Size Fits All” mantra is repeated!
I wish you the very best in your continuing journey that faces us all.
GODSPEED

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Hey Edmund 1971 thanks for the reply. My Urologist and Radiation Oncologist both believe that my recurrent cancer is in the prostate bed and surrounding lymph nodes. I’m only a month removed from the cessation of the radiation. My guts are all messed up, I go from constipation to diarrhea constantly. The majority of the time it’s diarrhea. My last shot of the Lupron was on June 30 and I and my Urologist have decided to stop the ADT right now and see how the PSA and Testosterone do. In the meantime as I mentioned earlier I will continue to have tests every three months.
I’m 70 years old, in great shape with no comorbidities. I had a heart attack in 2019 and had to have my Cardiologist clear me for the first Lupron shot.

Thanks again, I continue to fight this crap every day and refuse to stop

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