Posted 8/13/2020 9:31 AM (GMT -7)
First, a few questions about your status. Do you have a copy of your actual, full path report that was done after your surgery (not a summary)? If you don't have it, you should request a written copy -- this is an important document.
1. What is the final Gleason score there, G6 (3+3) or something higher?
2. What is the path status there? For example, pT2, pT3a, or pT3b
3. Where any positive margins noted?
4. If it was pT3, what other adverse feature were there? For example, any extraprostatic extension (EPE) or BNI (bladder neck invasion)? Although Gleason 6 (3+3) doesn't metastasize, it can grow out of the prostate locally.
5. Is there anything else of note in the path report?
6. What were your PSA readings since your surgery?
7. Current age?
A rise in PSA, usually defined as 0.2 and rising, is biochemical recurrence (BCR). Some men with BCR do not go on to clinical recurrence of their cancer (lesions that appear on imaging); some men do. The usual "salvage" treatment for BCR after a RP (when pelvic lymph nodes involvement is not suspected) is radiation limited to the area where the prostate was (the prostate fossa). It is understood that for many men, salvage radiation (SRT) will be over-treatment -- because few want to run the risk of doing nothing only to find years later that the cancer has metastasized and/or spread locally to the bladder or bowel.
The time estimate that I usually see cited for progressing from BCR to clinical recurrence, for those men who do progess, is 3-8 years (avg. 5). However, we now have more sophisticated scans (like Auxumin and PSMA-PET) that can detect lesions throughout the body earlier and better than a bone scan or CTs. You may want to discuss these newer scans with your docs -- if there are tiny metastases in the pelvic nodes, for examples, the radiation field of SRT can be broadened for wider lymph node coverage.
The "trigger" PSA for SRT (above, but sometimes below, 0.2) ) can vary according to many factors, such as your current PSA value, your PSA nadir (lowest value reached after the RP), the PSA rate of rise, the path staging (pT2, pT3) , Gleason score, any adverse features noted, current diagnostic imaging, your age, etc. The worse and more numerous these factors, the lower the PSA at which starting SRT is usually recommended. Note that some men haveca post-RP PSA that rises, but then plateaus at some low level (e.g. 0.1). Even when PSA is begun a fair bit above higher than 0.2, it is still termed "early" SRT.
A rise in PSA can be cause by prostate tissue left behind by the surgery, whether benign or malignant. In addition, G6 (3+3) tissue -- or even healthy tissue -- can form new lesions of a higher grade. Unless there is evidence of metastases, it is assumed that recurrence -- the source of the rising PSA -- is most likely in the prostate fossa, which is why SRT is generally the next step after BCR. Men who have had their prostates removed should have a very low and stable PSA.
If you can give us more details about your status, we can better suggests topic for discussion with your docs.