How to handle a relapse after treatment for prostate cancer

Marc B. Garnick, M.D., discusses what biochemical recurrence means and what your options are

“Am I going to die?” This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen (PSA) level has risen after he has already undergone treatment for prostate cancer (usually a radical prostatectomy or radiation therapy). The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan.

That’s usually of small comfort to the patient whose PSA has risen. It’s emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, it’s as if they’re dealing with another diagnosis of cancer, except this time it’s much worse because there is less likelihood of getting cured. A man’s confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly.

Which brings me back to my patient’s question: “Am I going to die?”

The simple answer is yes, eventually — we all do — but you may not die from prostate cancer. Of course, with prostate cancer, nothing is simple. This may be one disease, but it can appear in multiple forms, so every diagnosis or recurrence requires individualized assessment and intervention. To start thinking about the salient issues, see “Four key questions.”

Four key questions

If your PSA rises after prostate cancer treatment, answering four key questions will help you and your doctor determine next steps:

  • What were your risk characteristics, such as Gleason score, PSA, and cancer stage, at the time of diagnosis? (See Table 1.)
  • What type of treatment did you have? That will help determine your next treatment options.
  • How long has it been since you underwent initial therapy for prostate cancer? This helps indicate how aggressive follow-up treatment needs to be.
  • How fast is your PSA rising, as determined from several evaluations?

In practical terms, biochemical recurrence means that you are now dealing with a chronic disease, like diabetes, so that your clinical monitoring will have to increase and you may need to choose or adjust treatment to meet new challenges. Unfortunately, we don’t yet have sufficient research to provide clear guidance about when a second therapy (referred to as salvage therapy) should be considered after biochemical recurrence, and which type of salvage therapy is most effective in particular circumstances. (Salvage therapy is a terrible term, but I use it in this article because it is the standard name for follow-up therapy.)

For those who have already suffered a biochemical recurrence after being treated for prostate cancer — or dread each follow-up blood test because it might signal such a recurrence — this article explains what a rising PSA after treatment really means and what your treatment options are.

Table 1: Predictors of biochemical recurrence at time of diagnosis

Although a number of clinical factors contribute to your risk of relapse after treatment, the parameters below provide a simpler assessment of your chances of biochemical recurrence, based on your clinical profile at the time of diagnosis. For more sophisticated estimates, based on specific risk factors, see Figures 1 through 3.

Low risk (33% chance of biochemical recurrence within five years) Gleason score less than or equal to 6
PSA less than or equal to 10 ng/ml
Cancer stage T1c or T2a
Intermediate risk (50% chance of biochemical recurrence within five years) Gleason score of 7 (if 3+4)
PSA greater than 10 but no greater than 20 ng/ml
Cancer stage T2b
High risk (85% chance of biochemical recurrence within five years) Gleason score of 7 (if 4+3), or 8 or more
PSA greater than 20 ng/ml
Cancer stage T2c or more

Defining biochemical recurrence

As you are probably aware, both normal prostate cells and prostate cancer cells manufacture PSA. That is why the PSA level should fall to undetectable levels in men treated with radical prostatectomy, in which the prostate is removed, but is not likely to drop to zero in men treated with radiation therapy, even when treatment is successful. This is because after radiation therapy the prostate gland remains intact and can recover some function. This is also true if you received hormone therapy as part of your radiation treatment: As you recover, testosterone levels rise, and so does your PSA.

The real challenge is defining what constitutes a biochemical recurrence after a particular type of therapy. There is no consensus on this issue, but the working guidelines are summarized in Table 2.

Table 2: Guidelines for determining biochemical recurrence

Initial therapy PSA threshold Comments
Radical prostatectomy 0.2 ng/ml on at least two successive tests Some physicians continue to use a higher threshold of 0.4 ng/ml or greater
Radiation therapy (external beam or brachytherapy) Three successive elevations in PSA compared to nadir (low point), regardless of actual reading, according to the American Society for Therapeutic Radiology and Oncology Many oncologists use a working definition that biochemical recurrence has occurred if PSA levels are greater than 1–2 ng/ml 12 to 18 months following initial treatment.

Ideally, post-treatment PSA levels should be less than 0.5 ng/ml, but this is rare; levels of 0.6–1.4 ng/ml may occur.

Neoadjuvant hormone therapy and radiation therapy Unknown

Further muddying the water, it is not clear what PSA levels should be in men who have undergone neoadjuvant hormone therapy in addition to radiation therapy. Hormone therapy suppresses levels of testosterone; once the therapy is stopped, testosterone levels rise, and PSA generally increases rapidly until the hormonal environment stabilizes.

Moreover, some men who have undergone external beam radiation therapy or implantation of radioactive seeds (brachytherapy) experience a phenomenon known as PSA bounce, a temporary spike in PSA that does not necessarily indicate recurrence. Studies offer varying conclusions about how common this phenomenon is, probably because they use different definitions of what constitutes a “bounce.” Until more is known, if you have had some form of radiation therapy for prostate cancer and experience a spike in your PSA level, it is wise to ask your physician whether this could be a PSA bounce.

A common challenge

Rising PSA after initial treatment often comes as a shock to the person affected, but it’s actually a common problem. Studies indicate that biochemical recurrence affects roughly 15%–30% of men initially thought to be curable with localized treatment of prostate cancer. Certainly if you find yourself in this situation, you are not alone.

For example, a study published in the Journal of Urology, which followed 3,478 men who underwent radical prostatectomy for prostate cancer, found that 32% were likely to suffer a biochemical recurrence within 10 years. (The study actually followed patients an average of a little more than five years, but used actuarial tables to predict outcome at 10 years.) Another study, published in the Journal of the American Medical Association, examined the outcomes for 1,997 men who underwent radical prostatectomy and were followed for an average of a little more than five years, and found that 15% experienced biochemical recurrence in that time. (For further details about these studies, see “Biochemical recurrence after surgery,” below.)

Biochemical recurrence after surgery

Pound CR, Partin AW, Eisenberger MA, et al. Natural History of Progression after PSA Elevation Following Radical Prostatectomy. Journal of the American Medical Association 1999;281:1591–7. PMID: 10235151.

Roehl KA, Han M, Ramos CG, et al. Cancer Progression and Survival Rates Following Anatomical Radical Retropubic Prostatectomy in 3,478 Consecutive Patients: Long-Term Results. Journal of Urology 2004;172:910–14. PMID: 15310996.

Other studies indicate that a similar (or perhaps slightly higher) percentage of men treated with radiation therapy will experience a biochemical recurrence (see “Biochemical recurrence after radiation therapy,” below). For example, a study of 1,449 men with prostate cancer treated with brachytherapy, published in the Journal of Urology, found that anywhere from 19% to 26% experienced biochemical recurrence within 12 years, depending on the definition of recurrence. It should be noted that nearly half the men were also treated with either neoadjuvant hormone therapy or a combination of brachytherapy and external beam radiation therapy, which may have increased the success of treatment or delayed recurrence. And a study comparing the outcomes of 393 men who received different doses of external beam radiation therapy for prostate cancer, published in the Journal of the American Medical Association, found that 19.6% of those who underwent high-dose radiation therapy experienced biochemical recurrence within five years, while 38.6% of those who underwent conventional-dose radiation therapy did.

Biochemical recurrence after radiation therapy

Potters L, Morgenstern C, Calugara E, et al. 12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients with Clinically Localized Prostate Cancer. Journal of Urology 2005;173:1562–6. PMID: 15821486.

Zietman AL, DeSilvio ML, Slater JD, et al. Comparison of Conventional-Dose vs High-Dose Conformal Radiation Therapy in Clinically Localized Adenocarcinoma of the Prostate: A Randomized Controlled Trial. Journal of the American Medical Association 2005;294:1233–9. PMID: 16160131.

Assessing your personal risk

Several factors contribute to your risk profile. One important factor is whether you have localized or more advanced disease at the time of biochemical recurrence. As indicated in Table 1, your pretreatment numbers such as Gleason score and pathological cancer stage will provide some indication of whether the recurrence is local or metastatic. Also important is how much the PSA increased within a given time period (known as the PSA velocity) before treatment, and how long it takes for PSA to double in value (known as PSA doubling time) after treatment.

For example, two studies that looked at the relationship between PSA velocity and post-treatment outcomes in men treated for early-stage prostate cancer found that men with a PSA velocity of 2 ng/ml or less in the year before diagnosis had a much better prognosis than those whose PSA velocity was greater than 2 ng/ml per year (see “PSA velocity and prognosis,” below). In a study of 1,095 men treated with surgery, published in the New England Journal of Medicine, investigators found that men with a PSA velocity greater than 2 ng/ml in the year preceding diagnosis were 50% more likely to experience biochemical recurrence than the men whose PSA velocity was less than that. These men were also likely to experience biochemical recurrence faster and faced a greater likelihood of dying from prostate cancer than the other men. In the second study, involving 358 men treated with external beam radiation therapy, published in the Journal of the American Medical Association, researchers found that men with a PSA velocity greater than 2 ng/ml in the year preceding diagnosis were 80% more likely to experience biochemical recurrence than the others, and less likely to survive (see Table 3). Similarly, post-treatment PSA doubling time can also be used to assess the likelihood that disease is local or metastatic and provide insight into prognosis.

Table 3: PSA velocity before diagnosis and estimated chances of survival

An analysis of PSA velocity in the year preceding diagnosis reveals that it can predict the likelihood of survival seven years after external beam radiation therapy. (Similar findings have been reported for an analysis of men who underwent radical prostatectomy.)

Overall risk profile (based on PSA, Gleason score, cancer stage) When PSA velocity is less than or equal to 2 ng/ml per year When PSA velocity is greater than 2 ng/ml per year
Low risk 100% 81%
High risk 96% 76%
Source: Journal of the American Medical Association, July 27, 2005.

When the post-treatment PSA level doubles in less than six months, for example, and certainly when it doubles in less than three months, the cancer has most likely spread and therefore requires systemic treatment. Research has also shown that the length of time it takes PSA to double can be used to estimate likelihood of whether disease will become clinically evident (detected by symptoms and scans) following biochemical recurrence (see Table 4).

Table 4: PSA doubling time and outcome five years after biochemical recurrence

A study involving 2,809 men who were treated with surgery and subsequently experienced biochemical recurrence (defined as a PSA of 0.4 ng/ml or more) found a clear relationship between PSA doubling time and eventual clinical outcomes.

PSA doubling time Percentage of men without prostate cancer*
Less than 6 months 38%
6–11 months 46%
12 months–9 years, 11 months 62%
10 years or more 87%
*No clinical indication of local or systemic disease, based on digital rectal examination, transrectal ultrasonography, biopsy, or bone scan.

Source: Mayo Clinical Proceedings, June 2001.

Of course, estimates of average likelihood of progression are simply that — estimates — and may not indicate what is going on in your own case. So to better determine whether your cancer recurrence is localized to the prostate or has spread elsewhere, your doctor will not only look at your pretreatment numbers, but also restage the disease by repeating some of the tests you had at the time of your initial diagnosis. You will likely undergo a bone scan and an abdominal pelvic CT scan. You may also undergo a ProstaScint scan, which uses monoclonal antibodies tagged with a radioisotope to identify metastatic prostate cancer in lymph nodes and other areas in the pelvis. It’s important to note, however, that not all doctors recommend such tests because in most men who experience rising PSA, these scans will usually not reveal any clinical evidence of metastases.

PSA velocity and prognosis

D’Amico AV, Chen MH, Roehl KA, Catalona WJ. Preoperative PSA Velocity and the Risk of Death from Prostate Cancer After Radical Prostatectomy. New England Journal of Medicine 2004;351:125–35. PMID: 15247353.

D’Amico AV, Renshaw AA, Sussman B, Chen MH. Pretreatment PSA Velocity and Risk of Death from Prostate Cancer Following External Beam Radiation Therapy. Journal of the American Medical Association 2005;294:440–7. PMID: 16046650.

Knowing whether and when to act

If your PSA indicates that biochemical recurrence has occurred — or if you are tracking your PSA closely, to determine whether you may need to consider treatment — you probably want to know what your options are. But as you evaluate options, consider not only what to do, but whether and when to act.

Unfortunately, experts don’t agree about when salvage treatment for recurrent prostate cancer should begin, or which salvage treatments are best. Of course, if you experience biochemical recurrence and the cancer appears aggressive — as indicated by your pretreatment risk profile (see Table 1) or a PSA doubling time of less than six months — your physician is likely to recommend immediate treatment, probably with hormone therapy, to delay metastases.

But many other men will find themselves in a gray area, with clinical profiles and PSA doubling times that are not sufficient to trigger immediate salvage therapy. If you are in this category, your physician may recommend waiting to treat until your PSA rises to a particular level. That means you may have more frequent PSA testing, which can be nerve-racking but is necessary to detect progression earlier. (For more insight into what this feels like, see “A couple’s story: Tracking PSA,” below.)

Although many men diagnosed with biochemical recurrence will want to take immediate action to stop the cancer, going ahead with therapy for the sake of simply doing something may cause more harm than good. The risks and complications of surgery or radiation, already high when delivered after an initial diagnosis of prostate cancer, may become even greater when these therapies are delivered as salvage after biochemical recurrence. Data are sparse on the side effects of salvage therapy, simply because not many studies have been done on the topic, but I always advise patients in this situation to consider that any complications of the initial therapy may be increased if their abdominal and pelvic areas are subjected to a second therapy. For example, some research indicates that the likelihood of developing urinary incontinence after prostatectomy is greater following salvage treatment (where it may affect 20%–60% of men) than when it is the first mode of treatment (where it may affect 2%–15% of men).

It’s also wise to consider the impact of further treatment if you have other diseases besides prostate cancer, such as diabetes, cardiovascular disease, or a pulmonary disease such as emphysema. If you do, it is likely that you are on medications for these disorders, and are already dealing with significant health challenges and risks. Undergoing additional treatment for prostate cancer may add to these risks, or may require that you readjust medications you are taking.

Finally, remember that you have time to make an informed decision about whether and when to undergo additional treatment for prostate cancer following biochemical recurrence. The evidence shows that you can expect to live for many more years. For example, the Journal of the American Medical Association study cited earlier, which reported that 15% of men experienced biochemical recurrence in a little over five years, also analyzed what happened to the men afterward. The authors found that it took an average of eight years for the cancer to metastasize to the bones, and the men survived another five years after that — for a total of 13 years, on average, after biochemical recurrence.

Remember that average survival times are based on studies of men treated in the past, and sometimes as long as 10 or 20 years ago. What’s more, some of these studies (including the Journal of the American Medical Association study cited above) included men who did not undergo further treatment after biochemical recurrence occurred. It’s likely that these men would have survived for a longer time if they had received additional treatment after biochemical recurrence was detected (although longer survival would come at the cost of treatment side effects). For these reasons, the “average” chances may be much better for a man treated today. And such averages can never predict what will happen in your particular case. That’s why, when I talk with patients about studies like this one, I encourage them to make decisions based on their own risk profile. As shown in Figures 1 through 3, your particular risk will vary, depending on factors such as PSA level at diagnosis, PSA doubling time, and Gleason score. Finally, when it comes to evaluating your options, much will depend on whether you were treated initially with surgery or radiation therapy, with or without hormone therapy.

Figure 1. Preoperative PSA level and freedom from relapse

Preoperative PSA levels and freedom from relapse

Source: Journal of Urology, 2004

Figure 2. Gleason score and freedom from metastases

Gleason score and freedom from metastases

Source: Journal of the American Medical Association, 1999

Figure 3. PSA doubling time and freedom from metastases

PSA doubling time and freedom from metastases

Source: Journal of the American Medical Association, 1999

Options for men who had surgery

How long after treatment it took for the PSA to rise and how quickly it rose provide important clues to whether it’s likely that your cancer is localized or metastatic. Generally speaking, the prognosis is worse for men whose PSA never becomes undetectable after surgery, or rises quickly a short time after treatment. Prognosis is better for men whose PSA rises slowly and begins to rise a long time after treatment. A few scenarios will help clarify what the options are in each situation.

Some men learn right away that they have residual disease. The surgeon sends any tissue excised during the operation to a pathologist for analysis. If the pathologist finds positive margins — meaning that he found cancer cells at the borders, or margins, of the excised tissue — this means that you may need to undergo radiation treatment to eradicate the cells remaining in the prostate area.

Scenario 1. Sometimes the PSA level never becomes undetectable after a prostatectomy. This situation, which is fortunately rare but among the most challenging to treat, means either that some cancer cells remained in the prostatic fossa (tissue left behind during surgery in the area once occupied by the prostate gland), or — more likely — that micrometastases had already spread beyond the prostate. A man in this situation may need additional therapy right away. The options offered may be radiation or hormone therapy, or both, or an investigational therapy.

Scenario 2. Sometimes the PSA falls to undetectable levels for several months following radical prostatectomy, and then begins to creep up. Typically, a man in this situation learns during one of his follow-up tests that he has experienced a biochemical recurrence. If the PSA level rises within the first year after surgery, it usually indicates metastatic disease. The treatment option most often offered is hormone therapy (either intermittent or continuous).

Scenario 3. The PSA does not begin to rise until a year or more after surgery. This is more likely to indicate localized disease, although it is possible that the disease has spread. Your treatment options depend on the PSA doubling time — how quickly PSA is increasing. If your PSA doubles in less than six months, and certainly less than three months, your doctor may recommend treating the area again, but this time with radiation or hormone therapy, in order to eradicate the disease.

Scenario 4. The PSA rises a year or more after surgery, but the doubling time is slow (a year or longer). This is probably the best scenario of all, as it indicates that the cancer may be localized and not aggressive. In this situation, you may opt for active surveillance — monitoring PSA and periodically having other tests, but not necessarily choosing an active intervention right away.

Salvage options after radical prostatectomy

Most men who experience a biochemical recurrence after prostatectomy and decide to undergo treatment have three options. The best strategy depends on your risk profile and comfort with side effects.

Radiation therapy

Many men opt to undergo salvage radiation therapy. Although few studies have been done to evaluate long-term results, many men do respond to salvage treatment. One study involving 368 men who had initially undergone radical prostatectomy, for example, found that five years after undergoing salvage radiation therapy, 46% remained free of biochemical recurrence, and 92% were still alive; at eight years, 35% remained free of biochemical recurrence, and 80% were still alive. Other studies have reported that salvage radiation therapy is likely to be most effective in men whose Gleason score, PSA level and doubling time, and other clinical features indicate less aggressive disease (see “For more information: Salvage radiation therapy,” below).

Side effects. Be aware that radiation therapy delivered after a prostatectomy markedly increases the likelihood of impotence and may increase the likelihood of incontinence. If you are already incontinent after surgery, then having radiation therapy is likely to make the problem permanent. For that reason, most men who become incontinent after surgery will wait until they regain control over their bladder or rectum before undergoing postoperative radiation therapy.

For more information: Salvage radiation therapy

Buskirk SJ, Pisansky TM, Schild SE, et al. Salvage Radiotherapy for Isolated Prostate Specific Antigen Increase after Radical Prostatectomy: Evaluation of Prognostic Factors and Creation of Prognostic Scoring System. Journal of Urology 2006;176:985–90. PMID: 16890677.

Sengupta S, Christensen CM, Zincke H, et al. Detectable Prostate Specific Antigen Between 60 and 120 Days Following Radical Prostatectomy for Prostate Cancer: Natural History and Prognostic Significance. Journal of Urology 2006;176:559–63. PMID: 16813889.

Stephenson AJ, Shariat SF, Zelefsky MJ, et al. Salvage Radiotherapy for Recurrent Prostate Cancer after Radical Prostatectomy. Journal of the American Medical Association 2004;291:1325–32. PMID: 15026399.

Radiation with hormone therapy

Another option is to undergo hormone treatment while undergoing salvage radiation therapy, because this may increase the effectiveness of radiation therapy.

Hormone therapy

If the PSA doubling time is less than six months, indicating that the cancer is aggressive, radiation therapy may not be adequate, as it is likely the cancer has already spread. In that case, a better option is a full course of hormone therapy, which can delay the time of onset to bone metastasis.

But other considerations also come into play. If you are sexually active and want to remain so, hormone therapy may not be the right option for you. Or you can opt for erectile-sparing hormone therapy, which involves a single agent like bicalutamide (Casodex), or bicalutamide and finasteride (Proscar) (see “For more information: Erectile-sparing hormone therapy,” below). Another option is to go on intermittent hormone therapy, in effect taking occasional “holidays” from treatment. This allows men to recover some quality of life while at the same time reducing levels of testosterone, which fuels the cancer.

If you are elderly (defined as having less than 10 years of life expectancy), you may not want the full spectrum of hormone therapy because it causes other complications.

For more information: Erectile-sparing hormone therapy

Boccardo F, Rubagotti A, Barichello M, et al. Bicalutamide Monotherapy Versus Flutamide Plus Goserelin in Prostate Cancer Patients. Journal of Clinical Oncology 1999;17:2027–38. PMID: 10561254.

Salvage options after radiation therapy

If your initial cancer treatment was radiation therapy and you experience a biochemical recurrence, the salvage treatment you choose depends on whether you received external beam radiation therapy or brachytherapy, as well as whether you also received hormone therapy.

Salvage prostatectomy

When one of my patients experiences biochemical recurrence following radiation therapy, the first question I expect to hear is, “Can we just go in and take it out?” Salvage prostatectomy is a possibility for some men, but it is not used often, simply because it’s such a difficult operation. Radiation therapy causes scar formation and the development of fibrous tissue in the treated area, so that a surgeon may be unable to distinguish among different types of tissue. It may be difficult, for example, to distinguish the specific boundaries of the rectum and the bladder because of prior radiation scarring. Some highly skilled surgeons can perform a salvage prostatectomy, but the larger consideration is whether it is worth doing at all.

One could make a strong argument that in most cases, rising PSA after radiation therapy indicates systemic disease, and any type of local therapy — even salvage prostatectomy — is not going to solve the larger problem of cancer cells that have metastasized elsewhere. For those cells, you need hormone therapy.

Salvage radiation therapy

In certain unusual circumstances, if recurrent cancer is found only in a limited part of the prostate gland, it may be possible to place radioactive seeds in the area to eradicate the cancer. The techniques for performing this are still under investigation, and long-term data on effectiveness are not yet available. Be aware that it is not known whether this additional radiation will increase the risk of other types of cancers.


Another option, also appropriate only when a localized area of cancer is found, is cryotherapy. This freezes the prostate gland to kill any remaining cancer cells. This highly specialized treatment is not practiced widely, and substantial complications have been reported.

Metastatic disease: Hormone therapy

If your doctor determines that you have a metastatic rather than a localized recurrence, hormone therapy is your best option — and it is appropriate whether you initially underwent a radical prostatectomy or radiation therapy. Before a man who has experienced biochemical recurrence decides to have hormone therapy, however, the first question is whether he has had it before. Some men who were at intermediate or high risk of relapse (see Table 1) and decided to have radiation therapy initially probably also had hormone therapy beforehand because this increases the chances that initial therapy will succeed. If the patient had a hard time of it, in terms of side effects, he may not want to consider hormone therapy again.

Hormone therapy works by reducing testosterone levels. Because testosterone fuels the growth and development of prostate cancer, reducing levels of this fuel helps stop cancer from progressing — or at least slows the rate of progression.

Hope for the future

Experiencing biochemical recurrence can be emotionally devastating — there’s no doubt about it. But research continues about how best to treat men who experience a relapse following initial therapy for prostate cancer, and it is likely that new therapies will emerge in the coming years. In the meantime, stay informed about your treatment options and work with your doctor to determine whether it’s time to consider some type of salvage therapy.

A couple’s story: Tracking PSA

Joe and Patricia Shields* have been married nearly 25 years. Mr. Shields received a diagnosis of prostate cancer in 2001, at age 57, and underwent a radical prostatectomy. In the summer of 2004, a routine blood test revealed that Mr. Shields’ PSA had doubled, from 0.02 ng/ml to 0.04 ng/ml. It held steady for the next few months, then jumped to 0.1 ng/ml, where it’s remained for more than 15 months. Mr. Shields has not experienced a biochemical recurrence (see Table 2). Even so, the Shields are concerned about the fact that the PSA level has increased at all, and find themselves living in a gray area, where medical science can offer little guidance.

Joe Shields: I mostly put it out of my mind. The day I go in to have the test done is hard. The day I need to call in for my results is hard. But otherwise I try not to worry about it. It’s not that I’m cavalier about risk. But I could spend the next 10 years worrying about dying of cancer, and then die in a car crash.

Patricia Shields: I think there’s a gender difference in how we cope. Joe says, “This is the hand I was dealt, I can’t worry about it, I just need to get up and get on with life.” Meanwhile, I have a female, “protect the nest” outlook. There isn’t a day that goes by when I don’t think about it.

In some ways, learning Joe’s PSA increased was much worse than the initial diagnosis. The first time around, you’re in shock. Then you think it’s behind you. But now it feels like something hanging over us all the time.

Joe Shields: One aspect of this that has been difficult is the ambiguity. When I was evaluating my options the first time around, there were guidelines. I felt like I could make an intelligent choice. But with PSA elevation after surgery, there are no clear treatment recommendations.

*Note: Names and some biographical details have been changed to protect this couple’s privacy. All medical details are as reported.

Originally published April 1, 2007; last reviewed April 22, 2011.

Jack Stopforth

I had radical surgery in October 2012 and was told in my first post-op exam that my PSA had not been fully eradicated and was measured at 0.01. Six moths later (June 2013) I was told it had doubled, but at 0.02 was still very low and should be monitored: only if it shows growth after 3 quarterly blood tests would my physician recommend radiotherapy or other salvage treatment. I want rid of the cancer and would rather have immediate treatment. Should I insist?


I’ll be 70 in January 2014. I had open RP on 9/7/13 after Gleason 9 PC was discovered in 2 of 6 biopsy cores on 6/24/13. Pathology was not good: Gleason 9, SVI, pos. margin and extraprostatic extension at base with Gleason 7. No PC was found in the 10 lymph nodes removed.

PSA two months later is 0.1, which is not surprising and not bad IMHO, all things considered. I still have minor incontinence and have ED which I had prior to surgery. So I’m biding my time at this point waiting to talk to my surgeon.

Michael Heinlein

I had robotic surgery 4/6/2013 showed lesson 8 after surgery with positive margin cut in on area by left blood vessel and never which could not be saved 3 month blood test showed less than .oo6 psa before operation was 2.9. No lymp node involvement no semen or bladder either. 6 month psa was 0.014 9 months .023 and then a 6 week test showed .04. Doctor wants send me to radiation oncologist next week for his info. What’s my chances what should I be looking at? What questions should I ask and is radiation the way to go. Should I buy green bananas ? Anyone have similar experience and how it turned out.

Patrick Dawson

At 52 I had a Prostatectomy in Nov 2013 with a pre op PSA of 53 and eventual pathology report after surgery with Gleason 8
38mm tumor apex to base and both sides of the prostate with Margin and Extension..I chose not to have follow up Radiation because my first Post op PSA was undetectable….told the stats of chance of reoccurence by the Oncologist which are the same as here 85%…I guess some very nervous months await me!!


I had Gleason 7 (4, 3) I think it was 4, 3 any ways, I remember the combo was the best combo with T1C added in. It was found after my PSA hit 12 and two very painful biopsies. I was treated in the fall of 2011, proton beam. For the last three months my PSA has gone from 1.2, 2.7 to 3.8. I’ve undergone a bone scan, nothing, prostate MRI, nothing and tomorrow, a spinal MRI. Dr. wants to conclude that a accident I had, which scarred my spine, is just that, a scar. After that a biopsy then a sit down to discuss options.

I’m 65 years old very disappointed and confused as to what my options are. I feel that someone just put a medical harness on me. They tell me that at my age and, moving forward, it will always be something.

Vinnie StJohn

I had a radical prostectomy Dec 2012. 9 months later, my PSA rose to.2. 6 months after that rise, to .3 I was sent to an oncologist who did a PET and MRI with contrast. Everything was completely clear with the exception of a 1.2cm lytic lesion in my right proximal humerus. How can I have mestastasis with a PSA of.3? Also it’s lytic and not blastic.
Oncologist wants to be “sure” at the expense of open surgical biopsy which 2 other doctors disagree on. Lesion is metabolically active with an SUV as high as 5.5, yet X-ray reveal non-aggressive. I’m in no man’s land.

Don Jay

Hi, Im 56 y/o, 2 years ago I had RP via the da vinci robotic system. My highest psa was 6.44. Post surg, my psa was undetectable for approx 15 mos. Subsequently in Oct 13 my psa was 0.03, in January 14 it increased to 0.07 in May14 it increased to 0.10 and one month later this June it remains 0.10.
Path post surg indicates 0.9cm intra- postive margin w/ gleason of 4+3 . My urologist has referred me to the radiation oncologist, whom I saw last week 6/5/14. He is recommending radiation therapy. Your thoughts on if I should have the treatment as rx’d or should I take the wait and see approach. Your time and comments would be most appreciated, thank you very much!!!


I was stage pt3b gl9 at pathology post RP. PSA at two, five and eight months post op was .1, .2, and .3 respectively so I started lupron and IMRT. My Uro and RO both think PCa is still in prostate bed, but I don’t know why they think so. So I have taken the plunge hoping for a cure this time. What else could I do? Standing pat and doing nothing seemed like giving up. I have no PCa symptoms but side effects of ADT have started, primarily hot flashes, fatigue , upset stomach and bowels, and muscle pain. Side effects of SET have not begun. Can’t wait for those bad boys! I’m not sure I’ll get another three month lupron shot.


hi,,i had surgery in 2002 to remove my prostate. 11 years later my psa went up to .6 had radiation treatment. 33 hits..had another psa three months later and it was .8 ouch..four months later it was 1.2,,now i am worried. so the doctor put me on horomone far no side effects..but what i would like to know is why the radiation did not work…i am 68 years old…


Jim- My best guess is because the cancer is not where the radiation was targeted. I assume the pelvic bed was irradiated — were there scans that indicated something was there? Hormone therapy can keep the cancer at bay for an unknown period of time. If you want to try to pinpoint where the PCa is, you might want to try a different type of scan — research C-11 PET scans on Google.


I had high dose radiation treatment via SBRT for my PCa, gleason 6 (3+3), 5/12 cores, all on left side. I was 50 when diagnosed and treated. I get my first PSA test next month and the waiting for results is difficult to know if it worked. I think I have 93% shot of it working but as difficult as it is waiting to know the results, I feel for those of you who have gotten the results and know the initial treatment did not take care of it. My prayers are with you!


30 years ago I had PSA of 18. I had seed implant to prostate and 6 weeks of radiation. Not broad band. All was fine for for 25 years, PSA today is only 0.50 ,however, the radiation has caused scar to bladder and prostate that has been terrible for past 5 years.Broken scar tissue and blood clots blocking my urine off and on for 5 years.Finally I tried hyperbaric oxygen therapy for 80 hours and stopped the bladder blood clots.Now 3 years laterand years and 30 years after original treatment I have same problem with prostate blood clots. The oxygen treatment did not work this time.i pass clots on a regular basis praying they will not block me. Some have,most don’t I am 87 years old and very active or was until my activity caused scar tissue to break off.My doctor has no good answers.I say think twice before radiation. It comes home later and bites hard.

helen collins

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Like the other Jim (June comment) I had a radical prostatomy in 2003. Undetectable (<0.1) PSA until about 2010 then slow steady rise from 0.1 to 0.29 to mid-2014, now a jump to 0.42 in under 3 months. Abdominal CT and bone scans show nothing. I'm reluctant to start radiation so tomorrow I get a biopsy of (I think) the prostate bed. Then may have to weigh up risk vs reward – wait and see, or blast it before it goes any further? Can't say either option sounds good! I kind of hoped that the delayed and slow increase in PSA was a good omen but suspect that is probably unsubstantiated optimism.


Had a RPT on 8/31/10..Gleason of 4+3 and SI invasion. Went 3 years with an undetectable PSA. A recurrence of .07 to .1 ..Although still considereda low number to me any rise is not good..So..Had all scans they were all clear and opted for Radiation of the prostate bed with a total of 42 sessions over 2 months..after 3 months PSA was undetectable once again..Will follow up in 6 months but feel really good we might of got it for good..All it takes is a PMA..positive mental attitude to beat the dreaded rise in PSA..


Radical prostatectomy on 29March 2014.All margins clear.Psa pre-op 2.37.Psa post-op at 3 weeks forty-five.Psa at 6 weeks post-op seventeen.Psa 12 weeks post-op 1.29.Psa 18 weeks post-op 1.24.Decided to respond with treatment only when a doubling time excist.What tests can be done to be certain that the urologist did not leave prostate tissue behind during prostatectomy. Robotic da Vince surgery was executed.


my husband had a psa of 25 which rose to 49 in three weeks. There was no sign of any spread. He then had radical surgery and it was determined that his gleeson was 6. His PSA went down to .4 and then to .111 over the first 18 months. Now it has gone up to .3. The doctor wants to see him in 3 months to determine whether it is a trend. I am very concerned. Is this a sign of recurrence? What are his options?


My father had a gleason score of 4+3 PSA of 6.9. Radical prostatectomy in 2005. 16 of 32 lymph nodes positive. Had hormone injections and radiation. 6 years later PSA started to rise slowly. Now at 9 years we are at 10.1. Since January his PSA went from 6.54 to 10.1 last week. I am scared to death that this is it and that we could have done something more other than watch and wait. He has no pain, is 74 years old and is very active.


How do wives cope with testing every 3months after prostatectomy then a year later radiotherapy then 6years later a rise ,,that was 3 years ago bone scan clear…..the psa is now 2.95,,,,,
Husband has no symptoms but I am so anxious every 3 do wives cope?

nordin sahad din

Robotic prostatetomy was done in August 2009,at age 60,now am 66,first 3 years post-op follow ups psa was 0.01 starts to increase in December 2012,0.02 after every 4 months,0.18-0.23-043-(2013 reading)=0.39-0.42,latest 0.53(2014)repeated MRI and Bone Scan results are negative,but oncologist advice for radiotherapy,even after finger probe reveals nothing significant,another spcialist advice not to undergo the treatment,should wait and see,and monitor the future psa reading,basically I am fine and in good health,no urinary problems or incontinence,I am confused,PLEASE ADVICE,THANK YOU.

Caren Tidwell

My husband had 0 psa for years then after 6 years it suddenly went to 1.6 and the repeat in 4 months was 6.0 He was a Gleason score of 8-9 and a T3 at the original surgery 6 years ago. He is in poor health and can not walk 20 yards without resting, his legs give out on him and he is short of breath and coughs a lot. He is on dialysis. I have to dress him a lot because he is so weak. We just found out about the high PSA yesterday and go to the urologist next week…any guess if his has recurrent cancer and if so his outlook. I know it is just a guess and you have not seen him but what are the signs if it has gone to the bone or lung. Thanks in advance for answering. Caren

joe ragg

Gleason 10
radiation was the treatment psa was 2 at start
after radiation then seed implant psa 1
then 0.7
six month later 0.6
12 months 0.4
18 months 0.7 psa went up

what does this mean in layman’s terms

Jerry A

Diagnosed with prostate cancer in 2011 at age 63, Stage 2a. Had RP in September 2011 with PSA at 5.6.
Gleason score was 7 (3,4) with a tertiary small amount of 5. No positive margins, no lymph node involvement;tumor was contained and encapsulated. PSA remained <0.1 until November 2013 when it hit 0.2. In May, 2014 it hit 0.3 and in July, 2015 it hit 0.5. I entered a clinical study that had 2 Lupron shots over a 3 month period and Casadex regimen of 123 days. Had 39 Radiation treatments ending on November 17, 2014. PSA after start of hormones went to undetectable.
No significant symptoms during radiation. Hormone therapy left me with frequent hot flashes.
I was already incontinent from RP so present therapy didn't change incontinence.
Entering data of PSA tests into PSA Doubling time Calculator revealed a doubling time of 6.2 months.
Otherwise asymptomatic and hoping we got it this time

Jim P.

Diagnosed with P.Ca. at age 48 in 2008. Gleeson 6. Pre-surgery PSA was 3.1. Robotic RP in Novemeber 2008. PSA bounces around. First 2 readings after surgery .12 and .13 (after 2 months and 5 months). PSA fluctuated <.1 — .14 for first 3 years. Fluctuated .1 — .14 since Oct. 2011. Last PSA was .2 one week ago. Scheduled to have another PSAtest in 2 weeks. Assuming it will be .2 again.
Any advice?


Radical Prostatectomy (11.4 psa,9 gleason) in 2002 followed by 37 beam radiation treatments, and have been on 4-month Lupron for 12 years. PSA has been undetectable at every 4 month test. I am considering stopping Lupron(at least temporarily while testing psa every three months. Am now 68 years old, Type 1 diabetic for 18 years(on insulin pump for 13 years), and Ankylosing Spondylitis since 22 years old. Considering my diseases I am in good shape and strong. I worked a full career until 62 years old, now walk 2 miles daily with workouts, and do my own yard work. Any advice regarding Lupron stoppage?

Ben B

Diagnosed April 2004
Glesson 5+5 and PSA 8.

RP undertaken July 2004.
Jan 2005 PSA 5 Thus 6 weeks of Chemo.

PSA level at 0.1 (with slight variations ) until June 2013. Gentle but steady increases until this month, December 2014, up to 0.5.

I seem to fit the category where a relapse is active. 74 so slightly scared that may not have clarity to make correct decision and then follow through.
Life very active, work increasing. Comment and or advice would be really appreciate. Reading other posts is really useful and inspiring.

Great site, thank you.


My dad is 71 and had PC at age 63. Had it removed numbers stayed at .01 for 4 years the. Crept up to 1.4. He was given the 3 month shot to reduce testosrone which took his numbers back down to.03 for a year. He had some side effects like hot flashes that he didn’t like. His dr moved out of the area and he gets a new dr. Who says psa numbers are just that..numbers and that we can’t treat what we can’t see so with that he stopped taking the shots. Well 3 months ago he was a 3.0. Now today he is a 24!! The docs say they never have seen this before and are baffled. All scans and test show nothing. We are very concerned but what should he do?

Trevor Greaves

In October 2013 I had a RP using the
Da vinchi robot Gleason 7 clear margins PSA went from .01 to.018 in one year Dr sent me for a PSMA Pet scan which showed a small leasion at the surgery site margins were clear


Diagnosed January 2011 PSA 65, Gleason 9/10 no mets. 38 rounds of radiation and 3 years hormone therapy. Maintain negligible PSA throughout treatment <0.02. Finished treatment January 2014, 1st check up August 2014 PSA 0.5, 2nd check up January 2015 PSA 1.5, watchful waiting for next 6 months….advice?


Started hormone treatment after 33 hits of radiation.Cause psa did not go dowm. Had CT scan and bone scan. Did not see anything. Psa 1.2 before hormone treatment. Now after two shots Psa is dowm to 0.05..radiaction doctor total me that Psa would go up and go down after treatment. It would take two years before the Psa would settle down. Wonder if doctor started hormone treatment too early or not. This all started 11 years after removal of the prostate.


My husband had a RP by the DaVinci Robotic procedure in 2005 the PSA has risen in the beginning slowly now its gone from 191 to 332 its in his lymph nodes and bone but he opts for no treatment unless he has extreme pain in the bones where he will then accept radiation for the pain. He is still feeling pretty good so I feel this is a strange disease to grasp and it depends on each person how it reacts. I can never get a solid answer as what his survival time is and they probably don’t know but as long as he is feeling fine I guess that’s what he wants. So far I can’t find anyone on here that has that high of PSA so now I’m more concerned.


I had prostate cancer detected in 2008 from a biopsy. PSA levels over the previous year were bouncing between 5.5-7.5. Diagnosis was stage 1.
Three months after the prostatectomy(jan2009) the PSA was 3.5 and my urologist had a cow. Had more negative CT scans and 2 months later the PSA was somewhere ~2.0. Urologist put me on Proscar and went to another Urologist who did more biopsies and concluded there was a chunk of prostate tissue left behind from the original prostatectomy and that was the cause of the PSA. PSA continued down to ~.51 and I stopped taking the PROSCAR in early 2010.

After stopping the PROSCAR the PSA slowly went up and stabilized to between 1.47-1.11 between 2011-2014. In Feb14 I had to go the emergency room for a UTI and another urologist saw the prostate tissue and went in to take another biopsy. After the negative biopsy in May14, the PSA jumped to 1.67-1.81 between May-Dec14.In Feb15 saw a radiologist about Salvage therapy but the PSA went back down to 1.61. Radiologist is chomping at the bit for me to to do radiation, but seems a little cavalier about the risks (Didn’t even mention most in the above article). I think the PSA is still coming from the renegade prostate tissue and the urologists aren’t really very analytical. I also don’t think they understand the impact that stirring up prostate tissue has on PSA levels.
Sure wish I could find studies on what a ‘normal’ PSA would be for someone who had a chunk of prostate tissue left over from a screwed up prostatectomy. Don’t like the idea of doing radiation just in case.

Chris Redfern

I had a Prostatectomy in 2008 and have been having my PSA levels checked ever 6 months, and the PSA levels dropped with in weeks,to 0.05 and have stayed at, what i am told, a none recordable level since….I’ve been having my PSA tests now for 6+ years and have just started to have the test done yearly, the first yearly one i now have just received the results….and cant believe the results..the PSA level have increased….and doubled in a year to 0.1 and i am worried that after 6 + years i’m now going back to still having cancer.(recurrence) i am now and have been for some years been under my GP and am worried as i now need a referral to get back to a Urology department……


Age 52 : 2007 : PSA 1.7
Oct 2008 : PSA 3.11
Dec 2008 : PSA 3.71
Feb 2009 : PSA 4.69
Mar 2009 : Biopsy (8/12 infected) Gleason 7(4,3)
Apr 2009 : Radical Prostectomy
Jun 2009 : PSA < .1
Oct 2012 : PSA = .1
Oct 2013 : pSA = .2
Dec 2013 : PSA = .225
Feb 2014 : PSA = .234
Feb-Mar 2014 IMRT radiation treatment 38 sessions
Apr 2014 : PSA = .267
Aug 2014 : PSA = .336
Dec 2014 : PSA = .555
Mar 2015 : PSA = .674
Seems like radiation was ineffective
I confusion is : When to start hormone treatment.
Doctor says wait and see
I am anxious, waiting means allowing cancer to expand its volume and territories.
Any recommendations?
Would a 3D MRI buy anything
Lupron vs surgical castration to reduce testtosterone levels?


chris,,,wow…sounds just like me….over ten years after surgery before my psa started back up…took radiation, 33 hits..the doc said dont worry about psa readings for two year,,,than we worry about psa than,,cause it will go up and down..well my other doc said we are not waiting…1.27,,month after a shot of lupron it when down to 0.06..after two shots it is two more shot and than it is a waiting game for sure…if it did come back than i am on the shot for life…ha…i cant tell you what to do…but i did not wait..kill it..right..the only side effects i have is hot flashes, which i am having one now..ha..and little weight gain..jim..good luck


sorry chris,,,was not paying attention..madden who i was writing about..we are going thru the same thing..


Madden & Jim my dad is going through the exact same thing now. 15 years after radical prostatectomy his PSA level are now at 6. Salvage radiation is being recommended, CT scan negative, MRI scheduled…but they did not recommend hormone therapy as of yet. They said they would use that as a last resort for him.


bill,,,good luck,,,remember one thing..they are going after the lymphnodes,,cause the gland is gone…..not saying my radiation did not work..but my doc went ahead with hormone therapy…just in case…but like i said only side effects is hot flashes and little wt gain..

Ken Smith

I have a rising PSA after prostectomy. What’s wrong with opting for old fashioned physical castration?


Initial PSA 2834. Started hormone therapy and radiation. It was metastatic to bones, lungs and spine. After 6 mo on hormone therapy PSA increases from 16 to over 100. Chemo with docetaxel started for 6 cycles extended to 10. C diff has set in. On Vancomycin for 6 weeks while taking 2 more chemo treatments.

PSA went down to 18 now at 21. What would be recommendation for quality over quantity of life?


Four years ago I was found to have prostrate cancer had 42 sessions of radiation ,then had homo theorphy,for four years,the Tumor moved to the spine t4 I think,& found a spot on my pelvic,doctor said my cancer is aggressive t4 type of cancer or 1V should I say,Chemo did not work for me so I have being on Zytiga for the last two years,& this worked very well,but now my PSA has started to rise from .02 to 5.45 in the last two months,they the oncologyist think the Zytiga is stopped working,dose this mean my cancer is back,they are thinking oh external rad beams,they are not sure what to do next,the are going to run some more tests,I would like to know if you taught of cancer has returned ? Kind regards peter God bless


I want to enter this conversation.

I had a radical prostatectomy in 2006. My PSAs in the years that followed were never zero (to my chagrin), but they were low (hovering around .1). I was told by my family doctor and the urologist who did my surgery that it was nothing to worry about.

Last year the number started rising–at first .26, and then .76. Saw a cancer specialist who ran a CT scan that showed a “small mass” (how’s that for an oxymoron?) on my bladder. Again, he said not to worry–but after consulting with some of his colleagues, he called me back a week later and said that I should seek the advice of a (different) urologist.

Met with that urologist yesterday and he was the first person NOT to say, “Don’t worry about it.” I’m going to have a cystoscopy on Monday and he will take a biopsy. He has warned me that it’s likely (but not certain) to be cancerous, and that if it is, he’ll put me on radiation therapy.

As you can imagine, I’m not happy about this development. Looking for all the info I can find about similar situations.


Diagnosed PC 5-15, Gleason 7(3/4), t1c,RRP 6-21, clear margins, getting first PSA results tomorrow, 8-31. Nervous as hell


RP in 2003. Slow rise of PSA and watched until rose to .35 and then had salvage radiation in 2011. PSA never dropped below .2 and now slowly rising to .58. Gleason 6 and seems to be 2-3 year doubling time. Wondering when to start hormone therapy or is I can continue to wait. If anyone has personal knowledge on whether the Choline C11 scan works and can find cancer for curative intent.


RP in 1995 (age 50)PSA undetectible for 17 annual physical exams in a row. I figured I was “cured”.

Two years ago PSA unexpectedly showed up at 0.6. This was so totally unexpected that both I and my family doctor (GP) never even noticed the change. Missed my annual physical last year. This year, PSA is 5.7.

So my PSA has increased roughly 10 fold in 2 years. Go figure. Right now I am in search of new urologist since I am loading up to move out of state – great timing eh?. I am open to hormone treatment, but radiation is going to be a hard sell. I have lived without sex for 20 years, but I don’t want to risk incontinence as well. I am 70. Most people in my family live into their 90’s. I would be happy to make 80.


My dad had a gleason of 7 and had surgery. 5 years later he’s had a reccurance. He’s had radiation and now his PSA is 1.5. What exactly does that mean? My mom is hysterical because no one seems to have the answer. I’ve looked all over the web an no one has answers as to what it means after surgery AND salvage treatment AND the PSA is still there. No one’s PSA levels are what my dad’s are…could someone please help me…?



Please do not panic, there are always other options. Looks like your dad could probably go for hormone therapy next; this is something that you should discuss with his doctor. Best wishes!


Medical care is not a perfect science
It’s a crap shoot All is in the hands of
The Creator God Bless all


Husband had robotic rp 2 years ago followed by 33 radiation treatments because psa was not as low as Dr. Had hoped post surgery.
Pre surgery: 28
Post: 1.8
Post radiation: .02<
Has been doubling last 3 psa's: 1.8, 4, 8
Has had 2 rounds of CT and Bone scan..both times clear.
Is considering a study. Not sure what to think here. Need some help, He is having some trouble with the possible side effects of hormone therapy..can anyone help with some REAL effects and not just the "maybe this and maybe that happens with this treatment".
He feels better than he has in 5 years and has stopped all prescription and otc medications in the last 12 months just to clean out his system. He thinks that it is impossible that he has any cancer in his body, but all indications are that it is in there somewhere. How long before it shows up? Leaning toward study…but he doesn't want it to effect his life, work, etc. HELP!


See above story. I had my PSA retested. It went from 5.7 to 6.3 in 10 days. I guess they would just call it a six. Anyway, it was no fluke.

Saw a urologist in Florida yesterday. He said radiation after PSA is above 2.0 has not been shown to be worthwhile. My only choice is hormone therapy, but the side effects are horrible. Going in for my scans on the 19th. The idea is to delay hormone therapy as long as possible, and then decide if maybe I do not want to do anything at all. Hard evidence that any of this stuff actually prolongs a person’s life is sketchy and theoretical at best. I would actually opt for surgical castration over chemical castration to lower my PSA scores.


My dad’s PSA is now 1.8 after waiting 4 months. Based on what I’ve read online, after surgery and radiation and he still has a PSA rising, he’ll never be cured. Just gotta keep it at bay for however long we can.

My mother and I are both disabled and cannot take care of ourselves. He makes the money. On our own, our SSI checks will not support us. My mom is talking suicide because she refuses to live without him.

On top of that I have Lupus that could flare at any time.

Anybody got and friendly advice for me? Cuz last night my mom was looking up ways to shoot yourself properly online.



I can’t imagine what your mother is going through but there is always hope. My PSA has risen from 1.4 to 2.3 in just the last 3 months (10 months after Proton Therapy). I am expecting to go on to hormone therapy as I intend to fight the disease as best I can.

I will pray for you and your family,



My husbands PSA was 9.6 during pyhsical in December 2009, by the time he saw the urologist less than 1 month later 11.7
RP via DaVinci, positive margins with a Gleason of 9 (4+5)
After regaining urinary control, underwent salvage radiation. For 5 years his PSA was .01 rising to .02 in January 2015
July 2015 it had risen to .56 6 weeks later to .67
Negative CT of abdomen and pelvis, negative bone scan. Has anyone else gone thru this same scenario? I have noticed most people have said their scans were also negative after treatment and recurring PSA. Are there any other tests that he should have? I have forgotten his T score, but know it was very aggressive. Thanks in advance


here is a chronology of events in my case:
75% kidney function Loss at age 49.
3 procedures to stabilize the kidneys. Kidney disease settled at stage 2.
no heart beat for 20 seconds due to morphine overdose at hospital.
Blood clot; on levonox for 6 months.
Finally diagnosed with Stage 4 metastetised prostate cancer (Gleason 10, PSA 36).
Hormone therapy (Lupron every 3 months for life).
3 months of chemo (taxoter) PSA dropped to almost zero before the 3rd session, clinical remission.
49 sessions of radiation.
9 months on Xtandi (PSA went up to 10 after 9 months)
2 full body scans showed no sign of cancer)
One week later urine was full of blood. Cancer was too small to show up on any scans. Cystoscopy/biopsy showed cancer on bladder wall.
Up until this point (2.5 years after diagnosis I was body building, no stimulants/steroids ever) full of strength and energy.
Surgery to remove bladder & prostate unsuccessful, had to settle for Illium divergence.
4 months on Zytiga, PSA went from 0.9 to 2.9 This month. Turns out different test facilities use different machines/different calibration. Retest showed PSA 1.2. Plan for next step pending.
I have 3 young kids, still go to work and coach two soccer teams. My wife has seen me at my lowest points through all this. I keep crawling out of every relapse. Why? only God knows. I follow the doctor’s advice religiously. I watch what I eat/drink. I was jucing like crazy in the beginning, turns out that the vegetable and fruit juice lower the acidity in the body. Cancer loves acidity, and cancer cells commit suicide in alkaline body, so they say. I do it anyway. I promised my wife that I will fight to the end despite all my weaknesses and frequent desire for the end. From the beginning I took the role of a soldier going into war, I will either survive and come home or die in battle. No difference. If there is one word I would want on my grave stone, it would be “Defiant!”thats the only way you can stand up to this bully called cancer. for those of you who have this disease or supporting some one who does, stay defiant and keep hope. progress is made ever day. God doesn’t forget anyone.


You are my inspiration and the very rsoean I am filled with so much hope after my own recurrence this year. I am climbing along with you in spirit and praying you have a wonderful experience in Africa. Much love to you, Monsignor. You touch so many people’s lives on a daily basis truly Grateful that God brought you into our lives.


RP at age 58 in 2000. Gleason 7 (4+3), PSA 4.2, Stage III

I’m now 73. In 2013, PSA was 4.2. No symptoms. Had testicles removed in November 2013. In six months, PSA was 1.4. A year later it was .03. A year after that, 0.07.

Got another needle stick today and will get results in 2 days.


I had robotic prostatectomy five years ago. My PSA has been steadily increasing to 0.9 as shown in blood work done 2 weeks ago. My family doctor is referring me to a urologist. I’m expecting two options; radiation or hormone therapy. I’m 55. Anyone knows of any medical advancement other than these two awful options?

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