PSA rising with 3.3month doubling time after Radical Prostatectomy. Further actions?

Hi There - You understandably have a lot of questions and while I and others can offer some insights based our personal experience - the best source of medical information will be his MD.

A Gleason 7 score is on the edge of aggressiveness compared to my Gleason 9 that was diagnosed back in 2013. I underwent surgery that year and all of the margins appeared to be clear. In 2018 the cancer returned and I decided to undergo radiation and hormone therapy - Today I am apparently ok with a post op psa of 0.02 and NED ( no sign of disease. )

Prostate cancer is slow growing and while it is stressful to have to wait for an appointment just know it is not like other cancers. The rising PSA may suggest a spread - to what extent will need to be determined. In addition to a urologist it might be a good plan to set up an appointment with a radiation oncologist to begin gathering information. Many times at this stage a patient may be put on some form of hormone therapy prior to any additional treatment. The therapy will slow down further spread (it is not a cure). The therapy in theory also weakens the cancer so that radiation or proton therapy etc can be more effective.

Prostate Cancer is not a single disease and each patient is different and can be impacted in different ways . There is a lot of technology out there to treat a returning cancer. It is important to understand that some have a longer history of documenting patient outcomes while others like Proton therapy are relatively new and do not have a long record to draw upon. That said many patients have been pleased with their outcomes using Proton to date. It is always good to get a second opinion but given this is a returning cancer -- speaking with a radiation oncologist may prove to be productive. I would encourage you to do some research into the many treatment options that are available so when the patient in question is asked "what treatment do you want?" you all will have a better understanding of what the options mean. In the end it is the patient who will decide on next steps.

As to your question on PSMA Scans- yes they can locate cancer sites that other scans can not as they are more sensitive and use a different marking approach to locate distant cancers. IF the cancers are in clusters and not spread throughout the body a radiation oncologist can develop a plan to hit those specific locations.
I hope this is somewhat helpful - please feel free to reach out. I suspect others will also join in with more information Dennis(ProstateCancer.net TEAM)

While the kinetics of the PSA (successive rise, up/down, successive decline) are more important than the PSA number itself, you are still at what is technically considered 'undetectable'. Biochemical recurrence is considered two successive readings of 0.2 or above and you aren't there yet. I definitely don't think insurance is going to cover anything until your readings are over the undetectable definition which is > 0.04 and they will probably want to see at least two successive rising readings above 0.04 before you would be able to get treatment approval. But treating earlier with radiation is better like in between 0.1 and 0.5 (look into MRI Guided SBRT aka Viewray MRIdian.)


I would not get fixated on your doubling time until you hit 0.1. PSA can fluctuate and doubling times with reading differences of 1/100th's are questionable as to their utility in my opinion.


This is a very slow growing disease and many are 'cured' after receiving early salvage radiation therapy.

Oh just out of curiosity you said the cancer was "contained in your prostate" so I'd be interested in hearing a more detailed pathology report. I would assume you made that statement because there was no extracapular extension or seminal vesicle invasion?


The pathology report would give a lot more info including:


Were there positive surgical margins?
Were lymph nodes tested for cancer and how many did they test?
Perineural Invasion (PNI) is quite common, and not a big prognostic factor but that would be another thing on your Pathology report.
Positive Surgical Margins increase the chance you'll probably need salvage radiation to your prostate bed but I doubt any Oncologist is going to recommend any treatment until your PSA is at least over 0.1.

My Surgery was Jan 2021, age 62. Pathology was 4-3 with two places at the margins and some 5 found prostate confined. Due to history of other cancers in my family I was gene tested and BRCA2 defect was confirmed. Because of this history my urologist discussed salvage radiation but I waited to see the PSA readings. Undetectable at 3 months and 6 months but 0.04 at 1 year post surgery. Referred to Radiation and Radiologist leaned toward treatment right away but agreed to retest PSA 6 weeks. We discussed level readings and he did say that 0.2 was the trigger level but did not see the point in waiting until I get there and sooner treatment was advised. Next reading of 0.05 meet definition of 2 consecutive rises and wanted to move forward with radiation. Did suggest some preop scans but since I had done them before surgery I decided to do only abdomen and not bone scan. Waiting now on my 3 month PSA test to see where I am.
Radiology did tell me that Cyberknife was now for Salvage radiation.