Rising PSA years after radical prostatectomy

At 71, 2 and 1/2 years after my Radical Prostatectomy . No issues, until now PSA has been < .006.
Test last week 6 months after the last .006, showed a PSA .117 . Not thinking, I did ejaculate either the morning of or day before the test as well as an hour bike ride the day before. Don't know if that has impacts once prostate is removed. Would it be time for imaging tests already or wait and see the next test results in 3 or 6 months. Will be seeing urologist this week, but wondering what I might be asking or what to expect. thanks

Proton radiation is early 2010 at Loma Linda, an early leader in the utilization of proton radiation therapy. At that time, PSA was 6.7; biopsy indicated cancer on one lobe of the prostate gland. From 2010 until 2016, PSA zero/0; beginning 2017, PSA was noticed at .4. As October 2020, PSA at 2.47.

Question: Does the return of PSA levels positively indicate a return of prostate cancer? As most know, the rule of thumb is anything below PSA of 4 is normal.

At this juncture, I plan to wait alitle longer, then head up the road to Mayo Clinic in Jacksonville, Fl for a review of the options. For example, can another biopsy be done?

Any comments from first hand experience is appreciated.

I am 63. I was diagnosed April 2018. My doc prescribed all the treatments. Lupron, RP, chemo, & radiation.
The goal, in the Doc’s words, was to have zero PSA. And, for four years it was non-detectable. (>0.01). Success.
In my Doc’s opinion, you can’t produce PSA without a prostate. So IF, PSA becomes detected the cancer has returned.

Which It did this past December. So, I underwent more radiation. And if that doesn’t work they plan to put me back on hormone therapy (most likely Lupron)

In summary, it makes sense to me that if your prostate has been completely removed you should no longer produce PSA. If you still have a prostate, you’re gonna have PSA. If you don’t have a prostate but there is PSA present in your blood, you have cancer somewhere in your body.

I think that sums it up pretty well.

Treat too soon or too late...
Mono, doublet or triplet therapy....
Continuous, intermittent or as I call it, for a defined period, criteria to stop, actively monitor and criteria to start again....
Quality versus quantity....
A very heterogeneous disease both in the cells that are PCa and our own PCa.
Financial toxicity ...
A plethora of treatment decisions that by the very exponential nature of medical research and the prodding nature of PCa for many do not necessarily lend themselves to long term data about overall survival so we use progression free, radiology free and the window for that data is 3-5 years.
The diversity of options the different members of our medical team - urologist, oncologist and radiologist bring to the decision making process.

If there is any good news in this journey it's the explosion of treatment and imaging advances in the last 10 years which may mean most can manage this as a chronic disease.

My case is an example, diagnosed in 2014, surgery, BCR in late 2015, SRT in 2016, triplet therapy in 2017-2018, 4-1/2 years off treatment and now it's back....a Plarify scan shows a single PLN though we know there's more, micro metastatic...I'm sitting with my radiologist reviewing the scan, she's been on my team since 2016, we both talked about not having this conversation in 2016 since no imaging at that time could have seen this lone lymph node. My oncologist and I are talking about whether or not to add an ARI and for how long. I'm taking Orgovyx vice that damn Lupron, side affect profile is so much better...

We know how this journey can end, it's not pretty. So, I'll do what it takes to have a different end to my story.

Kevin

I think that sums it up pretty well.

Treat too soon or too late...
Mono, doublet or triplet therapy....
Continuous, intermittent or as I call it, for a defined period, criteria to stop, actively monitor and criteria to start again....
Quality versus quantity....
A very heterogeneous disease both in the cells that are PCa and our own PCa.
Financial toxicity ...
A plethora of treatment decisions that by the very exponential nature of medical research and the prodding nature of PCa for many do not necessarily lend themselves to long term data about overall survival so we use progression free, radiology free and the window for that data is 3-5 years.
The diversity of options the different members of our medical team - urologist, oncologist and radiologist bring to the decision making process.

If there is any good news in this journey it's the explosion of treatment and imaging advances in the last 10 years which may mean most can manage this as a chronic disease.

My case is an example, diagnosed in 2014, surgery, BCR in late 2015, SRT in 2016, triplet therapy in 2017-2018, 4-1/2 years off treatment and now it's back....a Plarify scan shows a single PLN though we know there's more, micro metastatic...I'm sitting with my radiologist reviewing the scan, she's been on my team since 2016, we both talked about not having this conversation in 2016 since no imaging at that time could have seen this lone lymph node. My oncologist and I are talking about whether or not to add an ARI and for how long. I'm taking Orgovyx vice that damn Lupron, side affect profile is so much better...

We know how this journey can end, it's not pretty. So, I'll do what it takes to have a different end to my story.

Kevin

This thread started out with a rather simple question: After radical prostatectomy, when do ultrasensitive PSA [uPSA] scores require action. I had this same question before my last appointment.
Background information I think I've correctly understood:
1) Historically, PSA post RALP was not considered actionable until it reached 2 [ng/ml.]. However, this was when PSA was reported as >1, 1,2,etc., so this only meant it was measurable (reached 1) and rising (reached 2).
2) Biochemical recurrence is defined as PSA >0.2 using a typical uPSA.
3) With ultrasensitive PSA, some research centers believe it to be actionable as low as 0.03. (Notice we've now dropped almost two levels of magnitude from 2.)
4) My urologist told me, if I understood correctly, he believes we should act [in my case] when it reaches 1.0. (Since I'm always a bit emotionally aroused in these discussions, could it have been 0.1? I don't think so, but....)
5) There is always someone somewhere who will prescribe more diagnostics or more treatment whatever our scores are.
6) All of us with prostate cancer [PC] diagnoses are prone to some level of anxiety regarding recurrence.
Why? Prying minds want to know, especially PC minds (with no reference to political correctness.)
As I understand it, the tradeoff is between overtreatment, just in time treatment, and too late treatment.
-Unfortunately the goal is never to eradicate the PC. Rather it is to delay its progress in the killing journey.
-Overtreatment is not only expensive, sometimes 100s or 1000s of times as expensive, but it runs the risk of using tools too soon, with some possibility they will not be available or as effective when they should be used. It also lowers quality of life (incontinence, erectile dysfunction, muscle mass, hormones, etc.)
-Just in time treatment is hard to identify because there is always more cancer there than any tool can measure, but every tool at its limits has "maybe" as the answer.
-Too late treatment is only evident when people die earlier than necessary, but even with too late treatment PC typically kills between 10 and 20 years, making good evidence hard to come by. uPSA testing has only been around for maybe 25 years? How long has it been commonly measured? (I think some studies have gone back and re-assayed old samples using uPSA methods.)
Anyway, it turned out my uPSA scores were in 0.01x range and the third was as low as the first, so "my time has not yet come." Still, if the third had been higher than the second, instead of back down to where the first was, I would have worried. AND I will now make a point of testing about the same time of day, although I don't think biking or sex are likely to have much effect in my post-prostate world....
Please, corrections are most welcome!