Rising PSA years after radical prostatectomy

Phil,
Thank you for sharing your experiences with salvage radiation. I am so glad that it has worked out well for you. Two questions: did you have the radiation done at a “center of excellence” or a local facility. Was it IGRT or IMRT or proton radiation?
At this moment I am in a different “place” than in March, 2024. I am in “watchful waiting” mode. Following my last post (March 3, 2024) I have had the following PSA results: 3/12/24 0.9, 4/30/24 0.09, 9/28/24 0.11, 10/22/24 0.11, and 1/03/25 0.11. Based on the latest results (and having a Decipher score of 0.36) I have decided to just sit still for a while and see how this plays out. The decipher report says that, in my case, radiotherapy prior to a rise in PSA above 0.2 does not lead to improvements in the outcome. So, in the future I will be having PSA test every three months and when the PSA gets to around 0.2, and assuming my overall health is favorable, I will probably have salvage radiation. Because of the low PSA and the Decipher results I probably will not do any ADT.
My radiational oncologist and urologist tell me that they have not seen many cases where the PSA “stalls” for a significant period of time. They both speculated that perhaps the entire prostate was not removed but that is unlikely. Time will tell.
To people who see an increase of PSA after radical prostatectomy I would say that there are three important considerations: 1) your PSA doubling time, 2) your Decipher (or similar genomics tests) results and 3) the actual value of your PSA. My feeling is that you treat aggressive recurrent cancer at a low (lower than 0.2) PSA and you treat recurrent cancer that is not aggressive at a higher level of PSA (perhaps, even a bit above 0.2). I must emphasize that I am not a medical doctor and those are simply my opinions based on what I have read.
Thanks again for sharing your story with me. I will write a continuation of my “journey” when I start salvage radiation.

Jackie, Just finished salvage radiation (25) and 6 mos Orgovyx. No major issues to report. Some extra BM’s first week or so after completion of therapy but all resolved now. No Urinary issues at all.
ADT is controversial - especially for G6’s and low Decipher scores; however, anything that “comes back” is tougher than G6 would imply, right?
Also, be absolutely sure you get radiation to the pelvic lymph nodes as well - something like 35% failure rate in salvage therapy if the nodes are not treated. Best.

I believe the Standard of Care treatment when you encounter recurrence is to combine 6 months of ADT with salvage radiation.

I would want another PSA test done by the same lab to confirm that there really is an increase

Recently (1 month) had a detectable PSA (.25) after 8 years of non-detectable. Met with oncologist who wants PET followed by radiation and hormone blocker (6 mo). Any thoughts on the importance of the hormone blocker?

I was told to have a PSMA Pet Scan done if the PSA reading was over .2. At that point, see where any spots are and if where the prostate was, Lupron Shots and if outside where the prostate was then use Targeted Beam Radiation at the spot location and poison the little bastar--
My Surgery RP was Aug. 3rf and first BW reading was .022 and the second one was. .061
My only son just got diagnosed with Paraganglioma at age 41 and healthy bumped out badly.

….there are also several online resources at PCF and PCRI that discuss treatment options for this specific situation.

I recommend getting an appointment with an oncologist that specializes in prostate cancer. You are presently below the recurrence threshold of 0.2 ng/ml, but the rising trend means it is time to discuss treatment options with a specialist that can talk you through them. With the slowly rising PSA, you have time to discuss and decide on your next treatment.

You probably have read enough but here’s my take on your rising PSA from experience, your doubling factor is 2+ years and you are not yet at the lower threshold of a PSA of .2. From my experience this is a monitor situation. Good luck and don’t hurry the situation. Mine came back and diagnosed as an aggressive recurrent prostate cancer. I had 39 radiation treatments and the anti hormonal shot Lupron. I tell you that it is NO walk in the park. My best to you and the person who is your support person.

Need a PSMA PET Scan, might be a biochemical recurrence in the prostate bed. My PSA slowly climbed to .24 a few years after a Robotic Prostatectomy. PSMA was neg. I received 38 radiation treatments, PSA now .02 for a year now.