Hogo, Lots of encouraging posts here, and all I can say is I agree with them. However, you are no doubt nervous since you calmly waited the 6 months but lo and behold went from .02 to .04. I can certainly understand being a bit uneasy at this rise. But please keep in mind a couple of things that might not yet have been emphasized.
1: Your history is:
RALP 11/15
3+3, neg SI, Neg, nodes, PNI +, clear margins
5 week PSA <.02
06/16 <.02
12/16 <.02
06/17 .02
So, for all you really know, your actual PSA starting 5 weeks post op until you lost your < was .019. Thus giving you an increase- on the day of losing the <, of .001. You simply do not know what was going on, or what kind of fluctuations were happening, down below that <.
So OK now, 6 months have gone by and that appears to have doubled. Nobody is going to like that. Still, while you wait for that clear trend to develop, and as you maybe actually slowly work your way up to an actual recurrence, or BCR, which you might elect to treat, the odds of someone with your pathology actually dying of this disease is very low. BCR- especially for risk such as you have, is a long, long way from dying(as I'm sure you know).
In fact, the odds of you even having significant clinical trouble is quite low (not counting possible problems from various treatments of course). In fact, considering your pathology, if you had never had surgery and just left it in there growing away, the odds of you having trouble were still quite low. Not zero, but very low. So keep that in mind while deciding how much to worry about
it.
All of that is with the assumption that you are a true G6 and were not under graded. And there is no reason to assume that you were graded too low. For G6 guys, according to one study, you have a 1.9% chance of BCR. But after all 16 of 857 G6 men who BCRed had RT, only 2 did not respond to RT, suggesting mets(0.3% of the original 857 G6 guys). But reviewing pathology of those 2 showed "Gleason pattern 4 elements in both.". So, 0% of the 855 with true G6 developed mets, and only 2(.23%) of the the 857 original G6 were actually found to have 4s in their score. Or if you prefer, of the already very low 1.9% of G6 guys who BCRed, only 12% of them actually ended up being 4s and having systemic disease.
In the other study, "Miyamoto et al[31] reanalyzed 2,551 cases of Gleason 6 organ-confined tumors in the Hopkins (Walsh) series and identified only 38 (1.5%) cases of BCR. Of the 38 cases in which a BCR developed, 27 (71%) were found on rereview to have a higher stage or grade than originally coded. Thus, a BCR developed in only 11 of 2,551 (0.4%) cases with true organ-confined Gleason 6 tumors. The same group combined data from four institutional radical prostatectomy databases and identified the rare instances (22 of 14,123 cases) in which patients with pathologic Gleason 6 tumors had lymph node metastases.[32] A review of the final pathology in these cases demonstrated that there had been undergrading in every case; thus, in no case had a true pathologic Gleason 6 tumor metastasized to the lymph nodes at the time of the patient’s radical prostatectomy.".
So, 22 of 14,123(.15%) of original G6 guys ended up with mets. But upon review, 100% turned out to not have been G6. All in all, those numbers show that you are truly going to have to buck the odds to end up with serious trouble from this, even if your PSA goes up a bit or even if you actually, finally, BCR. For you to get real trouble from this, you are going to be in the .15% who were something higher than the G6 which the pathologist thought they were. That is of course possible, but maybe knowing that can help you relax for a while as you find out if this is ever really going to crank up. The odds are vastly with you.
www.cancernetwork.com/oncology-journal/gleason-6-prostate-cancer-serious-malignancy-or-toothless-lion/page/0/1