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Worried about PSA rise post RARP

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User
Posted 18 Sep 2025 at 18:22

 

My husband had his RARP on 30 April this year. 

Histology report was Gleason 9 (4+5), PNI, urethral infiltration so EPE, however glands and seminal vesicles clear, there was cribriform growth, size of tumour was 45x40x36mm, pT3a, N0, Mx, R1.
His PSA pre OP was 67. 

Late June PSA post RARP was 0.1, in August it was 0.17, now in September 0.239. 
Husband was given appointment in August for radiooncology department on 30 September to talk about SRT. 
Given the just collected PSA result of 0.239, his urologist has also given him a referral, which refers to "delayed oncological aftercare check" - does this mean things should have gone faster?

Is it a bad sign that there is bcr so soon after RARP?

Edited by member 18 Sep 2025 at 22:53  | Reason: typo

User
Posted 19 Sep 2025 at 00:21

Hi Fragen,

"delayed oncological aftercare check" does seem to imply that somewhere along the line after his surgery there has been an unnecessary delay. However, I believe that  that generally salvage treatment is usually only considered when there are three consecutive PSA rises or it reaches 0.2. I can't see where there has been an erroneous delay. Unless they are saying the positive margin/urethral infiltrstion should have been treated earlier?

It's been mentioned before on here that if   post op PSA levels have never been undetectable, any rises, or levels above 0.2 aren't classed as BCR but as prostatectomy failure. Your husband first post op PSA was 0.1 was that classed as being undetectable?

It always best after RARP to have an undetectable PSA level. Your husband's high Gleason score, T3a staging, and positive margin are all factors which increased the risk of BCR/the likelihood of needing salvage treatment.

Good luck with any further treatment that they deem necessary. 👍

Edited by member 19 Sep 2025 at 00:34  | Reason: Typo

User
Posted 19 Sep 2025 at 00:34

It was not classed as undetectable, at least not expressly. He got that result from a lab, went to see doctor and the doctor apparently said that is ok, get another PSA test in 6 weeks. When that was 0.17 (August) the doctor apparently just said he needed radiation and gave him the apt for 30 September to see that department. 

Since then he went to his urologist, i think hoping his PSA might have decreased and thus negate need for treatment. Did a new test there last week and picked up the result today, where this "delay" was mentioned. He did not see the urologist though. 

I guess there was no real delay because after the 0.1, they tested again pretty quickly, which sounds like it makes sense. 

The urologist has written bcr as a diagnosis in the letter, but it does seem like it just was never gone. 

Another urologist I spoke to privately had thought he would probably be offered adjuvant radiation right away given his positive margin, so maybe his urologist had a similar view. However, i think he sees oncologists at the hospital. I will be able to join him for the next apt. 

User
Posted 19 Sep 2025 at 00:55

Hi again.

Although you are their mum, and mums always know best, I would let him make the decision. If he starts worrying about the children worrying about their dad, it may impede his treatment and recovery.

In the grand scheme of things, he's in a decent position and should be okay.

My kids were in their 30's when I was diagnosed. I told them. My grandkids were more the age of your younger children, I didn't tell them.

I feel sure that once you get over the setback of needing further treatment you'll all be fine. 👍

Edited by member 19 Sep 2025 at 01:20  | Reason: Typo

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User
Posted 19 Sep 2025 at 00:21

Hi Fragen,

"delayed oncological aftercare check" does seem to imply that somewhere along the line after his surgery there has been an unnecessary delay. However, I believe that  that generally salvage treatment is usually only considered when there are three consecutive PSA rises or it reaches 0.2. I can't see where there has been an erroneous delay. Unless they are saying the positive margin/urethral infiltrstion should have been treated earlier?

It's been mentioned before on here that if   post op PSA levels have never been undetectable, any rises, or levels above 0.2 aren't classed as BCR but as prostatectomy failure. Your husband first post op PSA was 0.1 was that classed as being undetectable?

It always best after RARP to have an undetectable PSA level. Your husband's high Gleason score, T3a staging, and positive margin are all factors which increased the risk of BCR/the likelihood of needing salvage treatment.

Good luck with any further treatment that they deem necessary. 👍

Edited by member 19 Sep 2025 at 00:34  | Reason: Typo

User
Posted 19 Sep 2025 at 00:34

It was not classed as undetectable, at least not expressly. He got that result from a lab, went to see doctor and the doctor apparently said that is ok, get another PSA test in 6 weeks. When that was 0.17 (August) the doctor apparently just said he needed radiation and gave him the apt for 30 September to see that department. 

Since then he went to his urologist, i think hoping his PSA might have decreased and thus negate need for treatment. Did a new test there last week and picked up the result today, where this "delay" was mentioned. He did not see the urologist though. 

I guess there was no real delay because after the 0.1, they tested again pretty quickly, which sounds like it makes sense. 

The urologist has written bcr as a diagnosis in the letter, but it does seem like it just was never gone. 

Another urologist I spoke to privately had thought he would probably be offered adjuvant radiation right away given his positive margin, so maybe his urologist had a similar view. However, i think he sees oncologists at the hospital. I will be able to join him for the next apt. 

User
Posted 19 Sep 2025 at 00:40

Also, did you tell your children about this sort of thing as it happened?

My instincts would be to tell them because to be completely honest, I am worried and I think they will sense something. He does not want to tell them anything. Of course it is far more his decision than mine as it concerns him. 

The children still living at home are 9yo, 13yo and 17yo.

I think he might even want to tell our oldest (20yo) on the other hand. 

User
Posted 19 Sep 2025 at 00:55

Hi again.

Although you are their mum, and mums always know best, I would let him make the decision. If he starts worrying about the children worrying about their dad, it may impede his treatment and recovery.

In the grand scheme of things, he's in a decent position and should be okay.

My kids were in their 30's when I was diagnosed. I told them. My grandkids were more the age of your younger children, I didn't tell them.

I feel sure that once you get over the setback of needing further treatment you'll all be fine. 👍

Edited by member 19 Sep 2025 at 01:20  | Reason: Typo

 
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