Rising PSA post Prostatectomy. Please, what should I expect or do?

@coa44
You should also be talking to a radiation oncologist If you hold off on radiation treatment much longer, it can be an issue as that ASCO link shows.

I just don’t understand why your urologist didn’t get you treated sooner.

@jeffmarc
Yours is very insightful and helpful. I have taken down notes which I will discuss with the Urologist during my upcoming office visit. Thank you so much.

@shalom7777777
Thank you very much for your kind response.

I don’t know where you are being treated, but they really let you down. I had a prostatectomy and 3.5 years later My PSA hit .2 and they gave me salvage radiation. That is really the standard of care for prostate cancer treatment..

The fact that you are not even having doctors talk about that issue being done immediately Makes your treatment seem suspect. It might make a lot of sense to go to a center of excellence and get a different opinion about what to do?

Here’s what the industry standard show about what should be done when you have your PSA rise after a prostatectomy

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/
Yes, getting on ADT after radiation would make sense. Having Enzalutamide Is an option, but it has a lot of side effects and causes fatigue for many people. Darolutamide Works just as well, but does not have the fatigue problem For most people and also does not pass the blood brain barrier and cause brain fog. Something you should discuss with your doctor. I know quite a few people who have switched drugs or after medical advice have just used Darolutamide. When it comes to ADT, you should ask for Orgovyx. It’s a pill you take once a day. When you stop taking it, your testosterone comes back much quicker and you feel better quicker. It also has fewer side effects than the other types of ADT. It doesn’t require you to take anything before you take that, Some of the other ADT drugs do. Some doctors like to use Firmagon, which is injected in the stomach, It can be very painful and is the worst way to get ADT. Just yesterday someone was complaining it feels like they still have a needle in their stomach.

Just some things to think about and talk to your doctor about.

Hi Coa44,
You came to a good place. All I can tell you is not to worry even if there is a reoccurance there are a lot of effective options as numerous people in this team will tell you from experience. Please wait and the more experienced people will soon chip in. All the best to you!