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

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!

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.

@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.

Strongly suggest 2d opinion with Radiation Oncologist asap.
See SPORRT trial.
Negative PSMA PET w/ rising PSA indicates residual disease in the pelvic floor region and/or pelvic lymph nodes.
My treatment, as well as 2 friends, was Salvage Radiation Treatment with short term ADT.
ROs and MOs are using different ADT regimens based upon Gleason score and other factors.
However salvage radiation to the WPRT and pelvic lymph nodes was the base therapy for me and my friends.
A COE would be my suggestion, and there also are excellent medical providers in many communities.
Prostate Cancer Foundation CFP.org has a free patient guide available by download and hard copy on advanced PCa. Also there is a PCF webinar from Jan 2023 (I think) on Rising PSA after RP.
I would encourage action sooner then Feb either with your provider or a 2d opinion.
Best wishes.

Don’t know why you were not treated with Salvage radiation/ADT when your PSA was consistent at 0.2; and then to let it rise continuously to its present level?!
Don’t want to be a sh** stirrer but your doc seems to have blown it. You still are very treatable but I would seriously consider having someone else treat you going forward. I would not trust this doc to be able to gauge success or failure at this point. Just my thoughts,
Phil

Strongly suggest 2d opinion with Radiation Oncologist asap.
See SPORRT trial.
Negative PSMA PET w/ rising PSA indicates residual disease in the pelvic floor region and/or pelvic lymph nodes.
My treatment, as well as 2 friends, was Salvage Radiation Treatment with short term ADT.
ROs and MOs are using different ADT regimens based upon Gleason score and other factors.
However salvage radiation to the WPRT and pelvic lymph nodes was the base therapy for me and my friends.
A COE would be my suggestion, and there also are excellent medical providers in many communities.
Prostate Cancer Foundation CFP.org has a free patient guide available by download and hard copy on advanced PCa. Also there is a PCF webinar from Jan 2023 (I think) on Rising PSA after RP.
I would encourage action sooner then Feb either with your provider or a 2d opinion.
Best wishes.