PSA Rise 20 months after surgery

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Regular Member

Date Joined Apr 2009
Total Posts : 20
   Posted 4/24/2009 4:04 PM (GMT -6)   
I had DaVinci Surgery in May 2007. Pathology was excellent. Gleason 6, No Lymph node involvement, no sem. vess. involvement, all PCa confined to the capsule. Total PCa less than 5%. No trouble with incontinence at all, 100% erections after 3 weeks.

Pre-Surgery PSA: 4.92

First PSA test post-surgery: 0.07 Aug 2007.
Second 0.04 (Lowest score) Nov 2007.
Third 0.04 Feb 2008
Fourth 0.04 July 2008
Fifth 0.08 February 2009.

Has any one who reads this forum had similar scores that went back down after they went up? Also, how successful is salvage IMRT after a few years in similar cases? Has any one had both IMRT and Intermittent Hormonal Ablation? What was the long term outcome?

I greatly appreciate your sharing of your experience. I have found so much about PCa very confusing and contradictory. It helps to hear real experience.

Thank you.

Regular Member

Date Joined Dec 2008
Total Posts : 377
   Posted 4/24/2009 4:19 PM (GMT -6)   


       You are still in the 0 club. Anything less than .1 is in the 0 club. Your variation is called noise because you like me have had the ultrasensitive test which may bounce around a little just because of how sensitive the test is. Some guys don't get this test because it can drive you nuts with worry.  They just get the test going to .1 level. As a matter of fact I just had my third test and am going to urologist on Monday for the results and checkup. So I know how you feel about this. I too have worried about salvage radiation if the PSA starts to rise, but you really don't have a trend yet. Nothing you can do about it except  keeping getting tested as uro orders. Take a big breath and just breathe, that's what I try and do every 3 months...............





my age=52 when all this happened,
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
First post-op PSA=.01 on 10/15/08,
Second post-op PSA <.01 on 01/15/09,
Incontinence gone in early December '08,
ED remains, using daily Viagra and 2x/wk bimix/trimix injections for penile rehab

Regular Member

Date Joined Jul 2006
Total Posts : 202
   Posted 4/24/2009 4:48 PM (GMT -6)   

I agree with mspt98. 

Anything less than .1 should be considered a zero.  The lab that reports on my blood test results doesn't even measure below .1.

PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.

Regular Member

Date Joined Jan 2009
Total Posts : 27
   Posted 4/24/2009 5:16 PM (GMT -6)   
Rp in 1995 psa 7.2 Gleason 2+1 (low Gleason) Present psa is 0.6.
I found these graphs years ago in an effort to understand psa rise after surgery. I have trended along the yellow line over the years. I have had psa bounce over the past 13 years also but the TREND is more more revealing to me. Of course a zero trend is possible too! Best wishes, Al

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 4/24/2009 5:16 PM (GMT -6)   
Well, I will agree that .08 is less than the magic .1 for detection...but the purpose of the ultra sensitive tests is to detect a rise in the PSA level...even if small. Based on the steady readings for the last three tests of .04...a jump up on the last test to .08 maybe noise...but could also mean that this is the beginning of a recurrence. I would think that your doctor would order another PSA test before making any suggestions for additional treatment.

I would personally want to wait for another test for confirmation that the PSA is rising before proceeding with additional treatment. But that is my opinion.
You are beating back cancer, so hold your head up with dignity
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

Veteran Member

Date Joined Oct 2006
Total Posts : 1211
   Posted 4/24/2009 9:27 PM (GMT -6)   
Hi BoisePSABantam,

As you can see by my signature, my PSA started to go up about 18-20 month after my open RRP. When it reached 0.08 my Onc, my Uro and myself decided that it was time for further action. The PSA had gone to 0.1 by the time I started my EBRT. It is my understanding that chances of successful salvage RT are best when started very early after recurrence. Hopefully your increase is just a little 'bounce', but if I were you, I would keep a very close eye on the PSA level and take action, if necessary, sooner rather than later.
All the best to you.

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA on the 26 Jan., 09, =0.05. PSA tests now every 6 month

Regular Member

Date Joined Apr 2009
Total Posts : 20
   Posted 4/25/2009 10:04 AM (GMT -6)   


Thanks for the good advice! I'm getting another PSA test this week and hopefully it's back at absolute zero. If not, I'll re-evaluate my options. I agree with the "Hit it Hard, Hit it Early" philosophy.

Prostate Cancer is a very hard to pin-down disease. I sure with it was more straight forward to treat.

One comfort is that while I see lots of recurrence, I don't see a alot of mortaility. Guys do live with the condition for a very long time (decades, in fact).

Thanks again.


James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 4/25/2009 2:28 PM (GMT -6)   
Good luck for the new test, make sure you come back here and let us know the results and further actions you take...
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Regular Member

Date Joined Apr 2009
Total Posts : 20
   Posted 4/27/2009 9:59 AM (GMT -6)   
UPDATE: Changed my PSA test to May 12th. Sister-in-law died and I don't want to subject my wife to any more bad news this week.

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 4/27/2009 10:28 AM (GMT -6)   
Sorry to hear that Boise, may she rest in peace and the family find comfort.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9

Regular Member

Date Joined Jul 2008
Total Posts : 29
   Posted 4/27/2009 11:57 AM (GMT -6)   
Clearly regular PSA's are required not only for the specific value, but the trend and to potentially identify "background noise" or lab tech error. In my case my one (1) year post RRP my ultra-sensitive came back AT (not less than) 0.01, which in and of itself is extremely low. My doctor said that he "sees it all the time"; in his experience that newer lab techs either leave off the < symbol out of laziness or fear that they had made a mistake, or that the lab equipment may need to be re-calibrated. He said not to worry about it, and to re-test in six months. I bargained him down to three months, and after anxiety took over I had my GP write me a lab request for my own test (same lab, same assay) which also came back AT 0.01. I quietly resigned myself that I would likely see 0.02 or 0.03 two months later and was actually at peace with it. Imagine my surprise and relief when the next test two months later came in at LESS THAN 0.01.

Point is there is slop in this test, as attested to by no doubt countless thousands. I don't know how much slop but it's there.
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, bladder resection margin, 17 lymphs clear
Three Post-surgical PSA's <0.01
Forth (one year 12/08) PSA 0.01 (not less than)
Fifth (on my own initiative 2/09) PSA 0.01
Sixth PSA back down to less-than 0.01 boooyah!

Roger G
Regular Member

Date Joined Apr 2008
Total Posts : 150
   Posted 4/28/2009 12:53 PM (GMT -6)   
Yes please write back and let us know how is went with the extra test. My own PSA is doing the same thing and I'd like to think it's just noise!

Email me please.

Age: 44 (42 when diagnosed)
DRE Small Ridge on prostate, PSA 1.5
07/2007: Diagnosed cancer, T2c, Gleason 3+4=7
09/2007: Laparoscopic prostectomy @ Hamilton General, 4 hrs.
01/2008: Still working on ED.

Regular Member

Date Joined Jul 2007
Total Posts : 86
   Posted 4/28/2009 1:45 PM (GMT -6)   
Your situation is very similar to mine as well.  I believe you need to find a good radiation guy and go the salvage route.  IMRT is so precise now that the chances of bad side effects are minimal.  Also, studies are showing that even if the radiation does not get you to .01 or below it does appear that it hampers the ability of the cancer to metastisize and therefore turns it into a chronic disease insead of a terminal one.  Just my opinion for what it is worth and good luck.
Age 45 at DX
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
PSA's have basically ranged from <.04 to .05 for two years.
no E.D. and no Incontinence, feel very blessed
PSA Nov 07 = .06
PSA Dec 10th 07 =.07
PSA Jan 4th 2008= .1
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
PSA April 18th 2008 =.03
PSA August 18th 2008 = .01 or less, test only goes down to .01

Regular Member

Date Joined Apr 2009
Total Posts : 75
   Posted 4/28/2009 2:07 PM (GMT -6)   
Take a deep breath. Relax.

Scardino's Prostate Book, p.393 said...
One study showed that less than half of men who at some point had a PSA that registered 0.2 or higher after surgery ever experienced a genuine rising PSA over time.

Larry Shick
Personal homepage incl. PCa story:
01/09: Diagnosed (age 60), PSA 4.4, pT2c, Gleason 7 (3+4), 7 of 14 cores, 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope), 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg

Regular Member

Date Joined Apr 2009
Total Posts : 20
   Posted 5/13/2009 12:29 PM (GMT -6)   
UPDATE: Got my PSA results: 0.08 again. Doc thinks that since my first and last 2 test results were that same level it may be that my blood chemistry may just evaluate to 0.08 more than 0.04. If it's not rising, and it stays below 0.1 it's not a problem. We'll just test away every quarter to see if it stabilizes.

Thanks everyone for your kind and wise advice. This is a very interesting community and I learn a lot every day.
Pre-Surgery PSA: 4.92
age: 45 at DX.
DaVinci 5/07
1st PSA 0.07 8/07
2nd PSA 0.04 11/07
3rd PSA 0.04 02/08
4TH PSA 0.04 7/08
5th PSA 0.08 2/09

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 5/13/2009 6:14 PM (GMT -6)   
Keep a watchful eye on it. But good news indeed.


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
My Journal is at Tony's Blog  

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 5/13/2009 6:19 PM (GMT -6)   

I to would keep a watchful eye on it. It very well maybe nothing but hey it is cancer we are dealing with. For now glad you are a member of the world famous zero club. Hope you stay with us for years to come.


peace and grace


My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores

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