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

To all my wonderful community, I listened and heard you well. This morning, I rescheduled my February 2026 appointment to the earliest available date in the first week of January 2026. During this upcoming office appointment, I will discuss with my urologist and ask him to proceed with treatment instead of further active surveillance.

I want to further add that my doubling time is 11.5.

Again, thank you so much for the warm support. I look forward to an ongoing relationship with you.

coa44:
I am comfortable saying you are welcome on behalf of everyone who has responded.
Universally, everyone on MCC is genuinely interested in sharing our experiences in an effort to help others.
Best wishes.

Hello Sir.
As a current cancer patient, i have been doing a tremendous amount of research, and have come to the conclusion that the the inportant thing is not to take each psa reading in isolation, but to calculate the doulbling time in days. I did a quick check on the psa readings and found that the doubling time seems to be slowing a bit, which meas it is still getting worse but at a slower pace.Still you need to keep an eye on it. I use snap gpt and copliot, You can put your exact numbers and see for your self.
In my case i had a running discussion with various treatments and it came back that the psa in 2045 would be .5
I recommend that you use them to give yourself a good working knowledge.
Best Wishes

@denany
I am very grateful for your support and analysis.
As I mentioned in an earlier post, I have brought forward my office appointment to the first in January 2026 where I look forward to discussing with the Urologist the need to start active treatment.
Thank you for the support.

COA44 - Here to help . you elected to for wait and watch , why ? Im not quite sure why you chose this path , what was your tiggers to do watchful waiting . Usually protocol is , EBRT ( external beam radiation) and maybe combined with ADT . You said your case was very complex , could you explain this further ? I think with the steady rise watching it rise is the last thing you want to do , but rather tackle the rising PSA with som therapy . I hope I can suggest something positive for you , but watchful waiting I dont think will change your situation. What is your RO saying for the best treatment for you? Take care and data positive. James on Vancouver Island .

@vancouverislandhiker
Hi James,
Thank you for the insightful support.

In an earlier post, I mentioned that I have brought forward my office appointment to the earliest date available, the first week of January 2026, for a multi-treatment therapies to start.

One month ago today, I discussed with the Urologist to proceed with a multi-pronged treatment on my next office visit which was then scheduled for the first week in February 2026.

I will keep the MCC posted as developments unfold.

Hello COA44

The use of active surveillance (AS) following BCR after prostectomy is an option that may be offered based on PSA doubling time and other criteria including post surgical pathology. The argument for AS versus salvage radiation is based on a growing body of evidence that suggests 33 to 50% of men with BCR following prostectomy are over treated as their recurring cancer was indolent or of low grade such that it would not have impacted their life negatively. The issue as you might expect is how to determine which of us have an indolent BCR based on the testing available.
It appears that you have been on AS for a couple years now post prostectomy. Did your doctor discuss the AS criteria with you ? It looks like you had one year of fairly stable PSA around .2 however it is now rising so definitely time to ask questions about treatment options. What was your PSA and post surgical Gleason score and decipher score? That would likely have been a part of any AS plan.

I bring this up as my surgeon is a big proponent of AS following surgery and BCR for some men with favorable pathology. This very topic came up last month on my one year prostectomy anniversary Telemed conference call. I asked my Surgeon what happens if I get a rise in PSA? He said based on the rate of rise and other factors he might likely recommend AS.
BTW , When I chose Dr Ahlering as my surgeon I had to agree to be part of his longitudinal study cohort. He is following UCI PCa patients for the next 15 years tracking their progress and one area of focus is exactly this topic of AS following RARP with a BCR.
Until stepping down last year to focus on research, Dr Ahlering was the Vice Chair of Urology at UCI which is a center of excellence.

@beachflyer excellent point regarding BCR. The rate of rise is SUPER important!
Mine took 5 yrs to get to 0.18 - but over the final year of that interval it really zoomed, which prompted me to have SRT.
Phil

My GU second opinion at a Comprehensive Cancer Center suggested waiting until I get a PSA of 2 if I BCR again and stated they would be able to find it and get it at that level. I can't recall seeing anyone that got a BCR PSMA Pet scan mention anything was found at low levels. What does "Chronic/incidental disease findings" mean? I hope they can sort this out for you.

@chippydoo
If you have radiation as your initial treatment, then the recommendation is not to do anything until the PSA rises 2 over the lowest it reached after radiation.

Some doctors like Dr. Scholz of PCRI fame, believe that you should just zap the metastasis as they come up. Waiting until the PSA hits 2 May be a little overdoing it but maybe not. Many people would want a PSMA PET scan when it reached 1.