PSA 1.3 - 11 years after RP

In 2013 I was diagnosed with PCa at age 53 and opted for RP surgery. Pre-op numbers were PSA = 8.7, 8 of 12 samples tested positive, Gleason 7 (3+4). After surgery my urologist indicated there was more cancer than expected, said it “extended to the margins but not beyond” and I seem to recall the Gleason changed to 4+3 though my memory is a bit fuzzy on that.

Follow up PSA tests every 3 months for 2 years. Then every 6 months for 2 years and annually after that.
2013-15: every 3 months - all undetectable.
2015-17: every 6 months - first 3 tests undetectable, last test 0.1
2017 - Wife and I move from California to Florida
2018 - 0.2
2019 - 0.3
2020 - 0.3
2021 - 0.4
2021 - My doctor’s office stopped taking my insurance and unfortunately I procrastinated until becoming eligible for Medicare this September.
Oct. 2024 - 1.3

This number alarmed me so while waiting for a follow up with my new doctor I did some research with Dr. Google and discovered recurrence is when PSA reaches 0.2 and secondary treatments have their best outcomes when PSA is between 0.2 and 0.5. Oops…looks like I should have found a new specialist after moving. I had a follow up appointment with my PCP and he was not concerned. I had to insist on getting a referral to a Urologist (appointment will be on 11/19). I have since read that it is not uncommon for family practitioners to be unfamiliar with post surgical PSA norms since a specialist takes over once the pre-diagnosis PSA becomes elevated. From the way he reacted when I told him what I read from Dr. Google I believe he will do the research to educate himself for future patients.

Anyway I’m having a hard time researching what this will mean going forward. Some of what I’ve read here sounds like I’m screwed. Has anyone else delayed secondary post-surgical treatment until the PSA was 1.3 or greater?

In addition to the urologist, you should get a medical oncologist with prostate cancer experience on your team. Preferably one at a major cancer center.

Hello grgisme and welcome. I also wouldn't say you are screwed but also would say you need to act with some sense of urgency. Your new PSA level most likely indicates the cancer is back so most likely you will need to take some action. Your PCP certainly didn't do you any favors.

Yeah, you should get a PSMA pet scan to see if a spread can be identified. But at this point it's likely that the urologist (new or old) would be out of the picture going forward. Get to a good radiation oncologist who has experience treating prostate cancer. If you'll tell us where you are located in FL perhaps one of us can make a recommendation.

Good luck; we are here to help.

Jim

If you start salvage radiation when psa is below 0.2, or maybe 0.4 at much, you have a fair chance to be cured. If you wait to have some spot detected by image, it is probable that only have ADT paliative treatment will be efective at that point. I do not want to be alarmistic, this treatment may actualy take cancer at bay for many years, but it is preferable to try something that may really cure.

I would consult with a medical oncologist from a Center of Excellence center for Cancer. They are usually associated with a major university. It would help if you got a PSMA Scan to find where the cancer is and then go from there. I went over a decade from my initial RP and salvage radiation before my PSA reached over 1. I just finished Proton therapy to 3 areas of my pelvic lymph nodes and now on ADT for 24 months. (15 months left). Good luck to you and visit often so we can track your progress.

I'm sorta in the same boat. My PSA started moving after around 7 years after surgery. Even up and down a few times. When it got to around 0.5 I did the PSMA scan and it showed nothing. I find it very confusing to read things like our chances of being cured are greater when radiation is done between 0.2 and 0.4. What if its benign tissue? I've also read that the PSA could level off and never cause a problem. I'm also aware know that pre surgery PSA, Gleason score and lymph node and margin involvement play a part. So knowing all of this, do we wait til something shows up then blast or blindly shoot the prostate bed and hope for the best? I thought 'generally' PSA has to be way up there to metastasize.