18 months post opp (radical prostatectomy)

Hi, 9 months after surgery I was less than 0.01, at 12 months (yesterday) mines gone up to 0.05...  Was told to retest in 3 months, if it gets to 0.2 then my consultant reccommended possible radiotherapy over 4 weeks (if needed). Was like you really upbeat thinking it was over, well I guess reality hit and reminded myself that we're all in this for the long haul. Try and keep positive, its hard I know 

Hello Cpl835 and welcome.

I presume the PSA results are from 9 12 15 and 18 months? If that is the case then one criteria for recurrence is a doubling within 6 months. Another is the velocity and this appears to going exponential indicating that something needs to be done. Just to clarify, my husband has not had a prostatectomy but he has had 3 recurrences following a T4 diagnosis 4 years ago. From what I understand there are 2 approaches the experts might follow. One is to presume that the cancer cells remain within the pelvic region and irradiate the whole area plus offer HT. The other is to wait until the cancer cells can be identified on a scan and then just target them with a localised therapy. Which path is taken will be determined by your initial histology, PSA, location, number of lesions. With your PSA numbers I think they will recommend acting sooner rather than later and there is some evidence that if it is hit when the PSA is below 0.25, but preferably below this, then there is a better chance at achieving a long term remission.

You are not back to square one because the majority of the cancer has been removed. This is just a hiccup which can happen between 25 and up to 50% of men who have Prostatectomies. 

In a response to NeverGiveUp on another thread I point to an article which might help explain things.

https://www.nature.com/articles/s41391-022-00638-y

Hi. Any negative news about our bodies is not good as far as the strain on our feelings and mental health is concerned. I had RP just under 2 years ago. My Consultant said the op went really well, I had negative margins and he was pretty confident he had grabbed all the little cretins. I felt very positive at that time and thought the whole business about PC was over for me. That was not the case though. My PSA has been rising steadily since then and as at 04/07/24 my reading is now at 0.3. Those like you and me though are not back to square one. There are routes which can be taken which statistically will provide us with many more years on this planet. We need to understand that there may be hickups along those routes but then there are still many many options available to get us back on track.

We are all guinea pigs to a certain extent and there is no single known best course of action. The specialists all have there own idea on sequence of treatment. Some will give RT immediately after the op but some will wait to see if the PSA level rises to a certain level. 0.2 seems fairly popular but for me it will be 0.4 before anything further is done and that will be RT without HT. Yes, I would have preferred for intervention sooner to get it done and dusted but having read so much on the subject and from speaking to my specialists I realise there are advantages and disadvantages to the choice of the next move. I personally have placed total faith in my specialists, realising there are risks to their choice and to all the other options. The statistics seem to show that there is no great variation betwen the options which are taken.

Thanks for your reply, my McMillan nurse has been telling me they won’t start looking for the issue until the magic .4 reading but as my numbers are now doubling I have read they may start RT on the prostate bed. I have my next appointment on 12th when my latest number will be discussed, so until then it’s just trying to be positive