Rising PSA years after radical prostatectomy

Hi @bettwils16, this is a question that several have asked and had answered in the Prostate Cancer group. For that reason I moved your message to this existing discussion:
- Rising PSA years after radical prostatectomy https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/

I did this so you can read the previous posts and connect with others to ask questions.

PSA tests can have fluctuations, so I’m encouraged that your urologist is sending you to be retested to see if the .24 is an anomaly.

You mention that you are looking for a new medical oncologist. Might Mayo Clinic be an option for you?

8 yrs post Robotic Prostatectomy , clean margins

Hi, PSA rising slowly last few yrs. Highest .20 down to .14 during 2022. Now .24 four months after .14. Going for a repeat as M.D ruling out error. I've been in the hands of my Urologist for these 8 yrs. Researching for a Medical Oncologist. Any suggestions if PSA is accurate? My medical center has an affiliation with MSK in N.Y. Thanks fir any suggestions

Yes. Apparently, the 0.5 is around when there are (unfortunately) enough PCa cells that are in sufficient clusters to be more readily detectable.

My RO feels that despite this, it's possible that at lower levels there has been clustering - particularly when the PCa is persistent (where PSA never dropped to a post radical prostatectomy level of < 0.01, which unfortunately reflects my own circumstance), as opposed to PCa recurrence.

This makes me simultaneously hopeful and fearful, which is really a weird place to be - kind of like feeling both overheated and cold at the same time. With any luck, the persistence is not related to metastasis but rather locally left-behind cells from the non-focal EPE and seminal vesical invasion. The RO tells me that he feels it "extremely unlikely" that the PCa has metastisized. The RO team here is very experienced, so I find some hope in that too.

This is quite the journey, isn't it.

In shared experience and support ... I am deeply grateful for communities like this and I hope I can be around long enough to pay all the support forward to the unfortunate many more who will find themselves with a ticket on the same boat.

- michael

My husband was diagnosed with T3b post surgery in 2020. His PSA level was <0.01 and has remained undetectable. We did extensive research and got multiple opinions. The consensus was to not proceed with adjuvant radiation, however, any signs of PSA returning, to jump on immediate Radiation. We learned PSMA-PET less likely to reveal anything <.5 PSA.

Best wishes.

Good plan. Best wishes.

My husband was diagnosed with T3b post surgery in 2020. His PSA level was <0.01 and has remained undetectable. We did extensive research and got multiple opinions. The consensus was to not proceed with adjuvant radiation, however, any signs of PSA returning, to jump on immediate Radiation. We learned PSMA-PET less likely to reveal anything <.5 PSA.

Best wishes.

Hello. I've been struggling to get a fuller picture of my prognosis and I'm at a loss over how concerned I should be (not saying that I'd expect to be *unconcerned*) and if I'm broadly on the right track.

* 63 years old, general health is pretty good (no other underlying conditions). 6', 210#.
* near Toronto, Ontario, (Canada)
* Diagnosed Oct 2021. PSA 13. Went up to 15 in the intervening 4 weeks between initial and retest requested by the Urologist.
* 12 core Biopsy. 11 PCa positive. Gleason mostly 6, 2 @ 7 (4+3) and 3 @ 7 (3+4)
* Perineural and Seminal Vesical invasion, non-focal EPE
* Retropubic Rad Prostatectomy JAN 21, 2022
* Pathology: Gleason Group 2, Margins, Bladder Neck, LNs (2) all clear. Perineural, SV, NF EPE confirmed. Staged T3B.

1) PSA test ~March 21: 0.053
2) PSA test 3 weeks later: 0.077
3) PSA test 3 weeks later: 0.092
4) PSA test 3 wks - 10d later: 0.13

* UTI between (3) and (4) PSA tests

So ... persistent (?) w/ rising consistently.
*** Q- While UTI can elevate psa pre RRP, can it also do that after prostate removal?

* Plant based diet. No pork / lamb. Limit 500g / week non-processed red meat. Skinless chicken, omega 3 fish. Some soy. Dairy mostly low-fat (1%). Reduced iced cream (addict). Some cheese.

* 1/2 plate veggies / fruits; 1/4 plate protein; 1/4 plate whole grains.
* zero eggs. reduced sugars. vastly reduced fast / processed foods. Increased berries. Pom juice.

* PSMA PET: should take 6-8 wks to happen. Expectation for detection is low, but RO is still recommending it.
* Starting Hormone Therapy soon (likely ADT, but not sure).
* Anticipate salvage EBRT (**any advice re particular RT tech / approach?**) quite soon after PSMA-PET.

* Looking for recommendations re: yes/no, dosage, frequency for
Saw Palmetto, White Button Mushroom powder, Nettle, Pom Juice.

* psa's scheduled for July 1, Aug 1. Consultation with Urologist mid August.

I have a Urologist, a Radio Oncologist, and a very helpful GP. No medical oncologist yet. (**I've been thinking that I should have one - at least the referral so any backlog delay in getting to see them will get burned away asap)**.

Concerned over:
- post surgical psa never being under 0.05 and that it's rising. "persistent" ?
- psa rising to 0.13 from 0.05 in 3 months, which, even though the numbers are small and I haven't hit 0.2 (expect likely by August), that the doubling in 3 months feels fast.
- rising psa in < 1 year after removal suggests higher likelihood of PCa caused mortality, *and* mortality from other causes.
- "early" interventions seem to be beneficial to high risk, recurrent / persistent PCa
- multiple treatments recommended for metastatic or castration resistent ... CAN or SHOULD one or some of these be accessed w/out having to be in Stage IV or determining castration resistance?
- time is passing, I have no MO, and at some point, it will be too late for "early" interventions.

I'm not sure if I'm overreacting or if there's real value to exploring beyond the SOC I seem to have been slotted into. What's the value of genome or dna testing? Might either lead to a sharpened or more refined treatment plan?

So, aside from "waiting" on the SOC, what should I be doing or pursuing? With whom would one consult with regarding my concerns and discussing the viability of a more aggressive plan?

While I have excellent family support, I live alone and my severe adhd causes me concern about long-term consistency and daily focus.

Given T3b, persistent PCa, (rapidly?) rising psa, and biochemical failure is almost certain to occur many months less than one year, I'm *very* concerned.

*sigh*

Hello. I've been struggling to get a fuller picture of my prognosis and I'm at a loss over how concerned I should be (not saying that I'd expect to be *unconcerned*) and if I'm broadly on the right track.

* 63 years old, general health is pretty good (no other underlying conditions). 6', 210#.
* near Toronto, Ontario, (Canada)
* Diagnosed Oct 2021. PSA 13. Went up to 15 in the intervening 4 weeks between initial and retest requested by the Urologist.
* 12 core Biopsy. 11 PCa positive. Gleason mostly 6, 2 @ 7 (4+3) and 3 @ 7 (3+4)
* Perineural and Seminal Vesical invasion, non-focal EPE
* Retropubic Rad Prostatectomy JAN 21, 2022
* Pathology: Gleason Group 2, Margins, Bladder Neck, LNs (2) all clear. Perineural, SV, NF EPE confirmed. Staged T3B.

1) PSA test ~March 21: 0.053
2) PSA test 3 weeks later: 0.077
3) PSA test 3 weeks later: 0.092
4) PSA test 3 wks - 10d later: 0.13

* UTI between (3) and (4) PSA tests

So ... persistent (?) w/ rising consistently.
*** Q- While UTI can elevate psa pre RRP, can it also do that after prostate removal?

* Plant based diet. No pork / lamb. Limit 500g / week non-processed red meat. Skinless chicken, omega 3 fish. Some soy. Dairy mostly low-fat (1%). Reduced iced cream (addict). Some cheese.

* 1/2 plate veggies / fruits; 1/4 plate protein; 1/4 plate whole grains.
* zero eggs. reduced sugars. vastly reduced fast / processed foods. Increased berries. Pom juice.

* PSMA PET: should take 6-8 wks to happen. Expectation for detection is low, but RO is still recommending it.
* Starting Hormone Therapy soon (likely ADT, but not sure).
* Anticipate salvage EBRT (**any advice re particular RT tech / approach?**) quite soon after PSMA-PET.

* Looking for recommendations re: yes/no, dosage, frequency for
Saw Palmetto, White Button Mushroom powder, Nettle, Pom Juice.

* psa's scheduled for July 1, Aug 1. Consultation with Urologist mid August.

I have a Urologist, a Radio Oncologist, and a very helpful GP. No medical oncologist yet. (**I've been thinking that I should have one - at least the referral so any backlog delay in getting to see them will get burned away asap)**.

Concerned over:
- post surgical psa never being under 0.05 and that it's rising. "persistent" ?
- psa rising to 0.13 from 0.05 in 3 months, which, even though the numbers are small and I haven't hit 0.2 (expect likely by August), that the doubling in 3 months feels fast.
- rising psa in < 1 year after removal suggests higher likelihood of PCa caused mortality, *and* mortality from other causes.
- "early" interventions seem to be beneficial to high risk, recurrent / persistent PCa
- multiple treatments recommended for metastatic or castration resistent ... CAN or SHOULD one or some of these be accessed w/out having to be in Stage IV or determining castration resistance?
- time is passing, I have no MO, and at some point, it will be too late for "early" interventions.

I'm not sure if I'm overreacting or if there's real value to exploring beyond the SOC I seem to have been slotted into. What's the value of genome or dna testing? Might either lead to a sharpened or more refined treatment plan?

So, aside from "waiting" on the SOC, what should I be doing or pursuing? With whom would one consult with regarding my concerns and discussing the viability of a more aggressive plan?

While I have excellent family support, I live alone and my severe adhd causes me concern about long-term consistency and daily focus.

Given T3b, persistent PCa, (rapidly?) rising psa, and biochemical failure is almost certain to occur many months less than one year, I'm *very* concerned.

*sigh*