Eight years post prostatectomy my PSA went from 0.085 to 0.185 in six months. I realize PSA increases are not linear but even so, should I suggest a three month interval between tests as opposed to the six month interval I've been on? I see him next week. Thank you.
Age 72 then, now 79
PSA: 3.98 3/1/2018
Biopsy: 4/12 (2 others suspicious all on rt side) highest percentage involved was 26
Gleason: 7 (3 + 4)
DaVinci: 6/14/2018
Pattern 4 40%, Gleason 7 (3+4)
EPE focal rt posterior, PSM unifocal rt posterior
Pathologic Stage pT3a, pN0
Home one week, high fever, readmitted, stayed two days then home.
PSA's since rising slowly
Incontinent big time.
ED
Hi Tico,
What was your PSA history after surgery? Given your post-RP pT3 pathology, has there been a discussion about the need arising for salvage RT? IMO you should have an R.O. on your team: you may not want to wait until a PSA of 0.3 and rising to have SRT.
Did you have a Decipher test on your removed prostate tissue to estimate the risk of metastatic progression? I would let an R.O. specializing in prostate cancer guide you as to the frequency of PSA checks, but it should be no less frequent than 3 months IMO.
You should discuss the best timing for a PSMA scan if your PSA increases.
What did you current uro say about testing frequency going forward? Surly he hasn't said it should now still be every 6 months. I would ask for a PSA retest perhaps a month after your most recent test, as both an accuracy check and to see if there is even a rise in the short interval.
Keep us posted.
Djin
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx
2013 TURP for BPH (90-->30 g) no PCa
6-6-17 Nodule (R) + PSA on finasteride: 3.6-->4.3
Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM, nodule neg
Bone scan, CTs: neg, 8-7-17 open RP @Duke, neg frozen sections, nerves spared
SM EPE BNI LVI SVI LNI(16): neg, PNI+, pT2c pN0 R0 MX, G9 (4+5) 5%, 64 g
Decipher 0.37 Low Risk, PSA 0.010 (3m)…0.281 (8+ yr)
What was your PSA history after surgery? Given your post-RP pT3 pathology, has there been a discussion about the need arising for salvage RT? IMO you should have an R.O. on your team: you may not want to wait until a PSA of 0.3 and rising to have SRT.
Did you have a Decipher test on your removed prostate tissue to estimate the risk of metastatic progression? I would let an R.O. specializing in prostate cancer guide you as to the frequency of PSA checks, but it should be no less frequent than 3 months IMO.
You should discuss the best timing for a PSMA scan if your PSA increases.
What did you current uro say about testing frequency going forward? Surly he hasn't said it should now still be every 6 months. I would ask for a PSA retest perhaps a month after your most recent test, as both an accuracy check and to see if there is even a rise in the short interval.
Keep us posted.
Djin
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx
2013 TURP for BPH (90-->30 g) no PCa
6-6-17 Nodule (R) + PSA on finasteride: 3.6-->4.3
Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM, nodule neg
Bone scan, CTs: neg, 8-7-17 open RP @Duke, neg frozen sections, nerves spared
SM EPE BNI LVI SVI LNI(16): neg, PNI+, pT2c pN0 R0 MX, G9 (4+5) 5%, 64 g
Decipher 0.37 Low Risk, PSA 0.010 (3m)…0.281 (8+ yr)
Post Edited (DjinTonic) : 7/4/2026 12:52:13 PM (GMT-4)
No Decipher, no RO, no nothing other than semi annual blood tests and similar meetings with the Uro/Surgeon. I'll bring up what you suggested when I see him next week, specifically another blood test in a month or so to get started. Thanks.
Equally important to the rate of PSA rise is the temporal type of the accent and in particular how close it tracks an exponential one. In theory, the parameters of an exponential rise can be derived from 3 time samples, yet, in practice, very few to solidly confirm anything due to linear curve resemblance and noise distortion. My personal rule of thumb is that for a no-nonsense prognostication at least 6 time samples must be available.
Hi Tico:
Sorry for the rising PSA. Yeah, I agree with Djin. Suggest you at least consult with RO and definitely test more often than 6 months. You don't want to let this get away from you.
Jim
Forum Moderator-Prostate Cancer. Age 62 (80 now). G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-15 yr: <1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1
Sorry for the rising PSA. Yeah, I agree with Djin. Suggest you at least consult with RO and definitely test more often than 6 months. You don't want to let this get away from you.
Jim
Forum Moderator-Prostate Cancer. Age 62 (80 now). G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-15 yr: <1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1
FWIW, when my PSA reached 0.12, I asked my uro/surgeon if it was time for an R.O. consult, and he said it was never too early. That was in Oct. of '24, and I have had peace of mind from the expertise of an R.O. In my particular case I was advised to wait for a PSA of 0.3 for my first PSMA. Otherwise, I might have not only have had a scan that was (probably) negative, but might have jumped the gun on SRT.
The "official" threshold of 0.2 adopted as the definition of BCR after surgery isn't a magic number that indicates some pathological event/change, but simply a research and clinical metric. Some men have salvage treatment earlier if their disease history warrants it. (With the advent of PSMA scans and our understanding of the natural history of PSA trends after truly curative surgery, I wouldn't be surprised if the PSA number for BCR is updated in the future.)
Djin
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx
2013 TURP for BPH (90-->30 g) no PCa
6-6-17 Nodule (R) + PSA on finasteride: 3.6-->4.3
Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM, nodule neg
Bone scan, CTs: neg, 8-7-17 open RP @Duke, neg frozen sections, nerves spared
SM EPE BNI LVI SVI LNI(16): neg, PNI+, pT2c pN0 R0 MX, G9 (4+5) 5%, 64 g
Decipher 0.37 Low Risk, PSA 0.010 (3m)…0.281 (8+ yr)
The "official" threshold of 0.2 adopted as the definition of BCR after surgery isn't a magic number that indicates some pathological event/change, but simply a research and clinical metric. Some men have salvage treatment earlier if their disease history warrants it. (With the advent of PSMA scans and our understanding of the natural history of PSA trends after truly curative surgery, I wouldn't be surprised if the PSA number for BCR is updated in the future.)
Djin
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx
2013 TURP for BPH (90-->30 g) no PCa
6-6-17 Nodule (R) + PSA on finasteride: 3.6-->4.3
Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM, nodule neg
Bone scan, CTs: neg, 8-7-17 open RP @Duke, neg frozen sections, nerves spared
SM EPE BNI LVI SVI LNI(16): neg, PNI+, pT2c pN0 R0 MX, G9 (4+5) 5%, 64 g
Decipher 0.37 Low Risk, PSA 0.010 (3m)…0.281 (8+ yr)
Post Edited (DjinTonic) : 7/7/2026 3:37:03 PM (GMT-4)
Tico - you should probably get another PSA test fairly soon as a check on the last result and to get another point to extrapolate from. Whether that is 30 days or 90 days could be discussed but 6 months is too long at his point IMHO. Your next stops appear to be with RO and/or MO as your urologist has little more to offer at this point if the climb continues.
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) Tert Gr5, pT3a pN0, Grp 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Grp 5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 sessions
PSA<0.10: 2019, 2020, 2021, 2022, 2023, 2024, 2025
7/2018 (66yr), PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3) Tert Gr5, pT3a pN0, Grp 3, SM, EPE, <3mm
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Grp 5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 sessions
PSA<0.10: 2019, 2020, 2021, 2022, 2023, 2024, 2025
Based on my personal experience with PCa, I fully agree with what Mumbo, Djin and others have said. I think you should have more frequent PSA tests and also see an RO
Over the past 20+ years, I have had open surgery, salvage radiation, and ADT. After each treatment my PSA remained stable for a long time, then began a slow but steady rise, and then surged over a very short time - a hockey stick curve.
I went nearly 8 years after surgery before needing SRT. Likewise, nearly 6 years after SRT before PSA rose to 0.2, and then a couple more years of very slow increase. Then wham, in just a few months in early 2018 PSA surged and doubling time plummeted to just a couple of months.
Then a couple of years on ADT (Degarelix, and then a switch to Lupron when Covid arrived making monthly visits for Degarelix shots no longer a good idea) and another spike in PSA as Lupron started to fail. And now under control again with Abiraterone (Zytiga).
Long story short, in each instance my experience was mostly steady or linear until it suddenly wasn't.
Jim
Age 80
2002-PSA 9.4
RP 2002 PT3B N0 MX 3+4 75% left small focus rt
.01 slow rise to 0.4
SRT 2010 +1node. Casodex
.0 thu 2014; .02 Oct14; .2 Oct16; 0.5 Jan17; 2.4 Jan18
6.6 May 18 + lymph node - Firmagon
0.45 Jun; .02 T<3 Aug
May '19 ADT vacation
.03 Oct'19; .48 Feb'20; 1.85 Aug
5.6 Jan'21 Auximen scan hot nodes
Feb-ADT
Jun-ADT Vacation
Sep 21 ADT
Nov 21 0.4 T <3 Zytiga
<0.02 Jan 26
Over the past 20+ years, I have had open surgery, salvage radiation, and ADT. After each treatment my PSA remained stable for a long time, then began a slow but steady rise, and then surged over a very short time - a hockey stick curve.
I went nearly 8 years after surgery before needing SRT. Likewise, nearly 6 years after SRT before PSA rose to 0.2, and then a couple more years of very slow increase. Then wham, in just a few months in early 2018 PSA surged and doubling time plummeted to just a couple of months.
Then a couple of years on ADT (Degarelix, and then a switch to Lupron when Covid arrived making monthly visits for Degarelix shots no longer a good idea) and another spike in PSA as Lupron started to fail. And now under control again with Abiraterone (Zytiga).
Long story short, in each instance my experience was mostly steady or linear until it suddenly wasn't.
Jim
Age 80
2002-PSA 9.4
RP 2002 PT3B N0 MX 3+4 75% left small focus rt
.01 slow rise to 0.4
SRT 2010 +1node. Casodex
.0 thu 2014; .02 Oct14; .2 Oct16; 0.5 Jan17; 2.4 Jan18
6.6 May 18 + lymph node - Firmagon
0.45 Jun; .02 T<3 Aug
May '19 ADT vacation
.03 Oct'19; .48 Feb'20; 1.85 Aug
5.6 Jan'21 Auximen scan hot nodes
Feb-ADT
Jun-ADT Vacation
Sep 21 ADT
Nov 21 0.4 T <3 Zytiga
<0.02 Jan 26
Thanks to everyone. Seeing the Uro/Surgeon this afternoon.
Dr changed my PSA schedule to every three months today. He seemed a little taken aback by the increase as well. Now we’ll see where we are in October.
Tico14 said...
Dr changed my PSA schedule to every three months today. He seemed a little taken aback by the increase as well. Now we’ll see where we are in October.
I would have asked for a retest just to make sure you didn't have a bad test. anyhow good luck to you.
age - 71
12/09 - PSA 6.8
G7 - 3+4 - all 12 cores positive
HT, BT, IGRT
PSAs .2, .3, .2, .3, .2, .1, .2, .2, .1, .1, .1, .1, <.1, <.1, <.1., <.1, <.1, <.1, <.1, <.06, <.06
4/6/26 - PSA <.06
"Surgery for the primary treatment of prostate cancer should be illegal" -- Herophilus
https://www.instagram.com/edraderphotography/
I'd begin PSA testing monthly plus ctDNA testing and imaging. All the best!
Benign biopsy at 47-PSA 20.4. Metastatic at 57-PSA 10.1. RP in 2016 followed by SRT to bed. 2018 advanced imaging and SePLND in Europe. Since June 2021 uPSA holding 0.03X, still no ADT. DX'ed metastatic melanoma Sep 2024. Have learned twice to not give cancer time and obscurity. Maintaining excellent health and fitness. Grateful! Murray Keith Wadsworth, author, podcaster: sheeporwolfcancer.com
Benign biopsy at 47-PSA 20.4. Metastatic at 57-PSA 10.1. RP in 2016 followed by SRT to bed. 2018 advanced imaging and SePLND in Europe. Since June 2021 uPSA holding 0.03X, still no ADT. DX'ed metastatic melanoma Sep 2024. Have learned twice to not give cancer time and obscurity. Maintaining excellent health and fitness. Grateful! Murray Keith Wadsworth, author, podcaster: sheeporwolfcancer.com
Post Edited (NanoMRI) : 7/22/2026 9:18:31 AM (GMT-4)
I would certainly consult with an oncologist, in the near future.
Adding an oncologist to one's team is always in one's best interests, looking towards the future.
Keep us informed ~ we are here to support you!
CYCLONE ~ # Iowa State University
PSA At Diagnosis In Year 2013 : 138
Initial Diagnosis: Advanced Prostate Cancer, With Metastases In Both Lungs
Age At Diagnosis: 48 years
ADT Treatments: LUPRON, FIRMAGON, & currently ZOLADEX
Subsequent Treatments: Chemotherapy (TAXOTERE) & ZYTIGA & RADIATION
Additional Consultant - Dr. KWON - Mayo Clinic
Current PSA Level: < 0.10 - Undetectable Range - Treatments Ongoing
Adding an oncologist to one's team is always in one's best interests, looking towards the future.
Keep us informed ~ we are here to support you!
CYCLONE ~ # Iowa State University
PSA At Diagnosis In Year 2013 : 138
Initial Diagnosis: Advanced Prostate Cancer, With Metastases In Both Lungs
Age At Diagnosis: 48 years
ADT Treatments: LUPRON, FIRMAGON, & currently ZOLADEX
Subsequent Treatments: Chemotherapy (TAXOTERE) & ZYTIGA & RADIATION
Additional Consultant - Dr. KWON - Mayo Clinic
Current PSA Level: < 0.10 - Undetectable Range - Treatments Ongoing