Biomechanical Recurrence

Amelie, the clear PET scan is good news as is a reducing PSA but those figures are much higher than they should be. The oncology appointment is important at this stage and I would want to know why the PSA is going down and what impact this will have on the likely SRT recommendation.

No mate, sober as a judge. 😇

View Dr Scholz's video.

https://youtu.be/JXRhzi0Z6qQ?si=SpZ03jiZ37nObKc1

Right at the beginning of the video, he deals with, in his words, not mine 'low' post-op PSA  levels. Which he clearly describes as 0.1 and 0.2 levels, that remain stable. He, like we all, knows that ideally PSA level should be undetectable or at least below 0.1 after surgery, but adds an exception, to those with 'low' stable levels.

Amelie's husband has had similar 'low levels' that are actually getting lower over the past few months from 0.32 to 0.28 to 0.24. If patients continue at these levels, Dr Scholz clearly states they can still be deemed 'cured'. Again his word not mine.

Knowing that your levels have been hovering around 0.1 levels, and the understandable worry it's caused you, I was going to pass the video link to you by pm, to put your mind at rest.

Edited by member 21 Jan 2026 at 19:10  | Reason: Typo

Hi, Wife-of YM

On this particular conversation, my responses aren't based on experiences. Fortunately, I have not yet, had to deal with BCR. However, even after three years of being 'cancer free", it's something I'm still mindful of, and research.

It is, as you suggested, possible that Amelie's husband scan didn't pick up any mets, but it is also possible and probably more likely, as Dr Scholz has clearly explained, that some prostate tissue which was not cancerous, had been left behind, causing these 'low' and stable PSA levels.

If I were in Amelie's husband's shoes, I'd be asking, is salvage treatment necessary when my 'low' PSA levels are gradually getting lower, and my scan is clear. Is it possible that these levels are caused by prostate tissue that was left behind and non cancerous?

The only thing I'd like clarifying in Dr Scholz's video is, if a patient goes from undetectable PSA levels to 0.1 and 0.2 levels, are they viewed differently to patients who've always been at those 'low' levels after surgery?

Edited by member 21 Jan 2026 at 19:32  | Reason: Typo

Hi again.

Thank you for your very kind comments. I'm sorry if my reply gave the impression that I was somehow offended by something you'd said. That was not the case. Often comments on here can be 'lost in translation.' 🙂

In Amelie's husband's case, I'd never heard of repeated post op PSA levels as high as his, which had not ben acted upon. I had always thought any three consectutive rises of PSA after surgery or a PSA level equal or greater than 0.2 was deemed BCR, and would normally trigger further investigation or salvage radiation and HT.

Before I posted my understanding of the situation, I thought I'd double check, and that's when I found Dr Scholz's video. It was the first time since I've been on the forum, that I'd heard anyone say that sustained and stable PSA levels of 0.1 and 0.2 levels may not be a concern and may remain at these levels for an indeterminate time.

Of course, on the other hand, such levels can often progress.

I'm not sure what the lady's husband's first post op PSA was, but she states about 5 months later, it had risen to 0.32.  However, over the last few months it has fallen to 0.24. His PSMA scan was clear.

I'm not medically trained, but I'd have thought, as his PSA is falling, and his scan is negative, and as Dr Scholz states that these low PSA levels can be harmless, salvage treatment might not be necessary?

It seems illogical that they'd start salvage treatment at 0.24 with a clear scan, when they held back at 0.32 and 0.28 levels when they were unsure of his scan results?

Unless there are other factors unbeknown to us, I'd be asking if my PSA could be further monitored, before having further treatment.

Edited by member 21 Jan 2026 at 23:18  | Reason: Typo

Hello again, mate.

I haven't a clue how unusual it is. Dr Scholz doesn't mention how common it is. He just classed non cancerous pre op PSA levels of 0.1 and 0.2 as exceptions to general cancerous causes of BCR.

As I mentioned in my early posts, we have limited information on Amelie's husband's post op histology and initial PSA results. As his medical team have been happy to monitor his situation for the past 10 months,  I'd have thought that his post op histology was favourable.  During that time, the steady decline in his 'low' level PSA and a clear PMAS scan, seem to justify their decision to hold back from any further treatment.

As I said, although my PSA has been 'undetectable' since my surgery three years ago. My post op histology wasn't good. Gleason 9 (4+5), cancer staging T3a (capsular breach and EPE) both factors which significantly increase the risk of BCR. On the plus side, I did have negative margins.

According to nonograms, despite being 'cancer free' for a long time, I'm still at quite a high risk of having to deal with BCR. That's why I'm particularly interested in folk on here who are in a similar position to me, and why I research the treatment options of those with BCR.

I've noticed recently, that unfortunately three posters, who had been 'cancer free' for the same time scale as me, have just been diagnosed with BCR. Which goes to show you can never declare, "I'm cured!"

I have followed your story closely, it is similar to a couple of others on here, who have have developed 'low' level PSA results, years after surgery and have been left with dilemma of whether they need salvage treatment or not.

I'm very pleased that your PSA seems to have stablised at these 'low' levels. I hope they continue to do so, mate, and that you never require salvage treatment.👍

 For those who have been 'undetectable' for years, then suddenly face possible BCR, I've never been able to establish, exactly where does the PSA rise comes from. Is it dormant mets that have suddenly sprung back to life, or are there other 'harmless' reasons that could cause these miniscule rises. Has anyone been able to identify exactly what caused yours?

I found Dr Scholz's video enlightening. Until viewing it, I didn't know there are post op men that can have stable 'low' level PSA that never causes any problems.  I would, however, like clarification on whether this group always had these  post op levels or does it include men, who like you and me, who were initially undetectable?

 Logically, I'd have thought, post op men who had stable 'low' level PSA, caused by harmless prostate tissue left behind, would have always shown 'low' level PSA and never developed it years later?

Anyway, back to Amelie's husband. I hope that he is in the unquantified group of men, whose 'low" level post op PSA, is caused by harmless prostate tissue left behind, and nothing more sinster. 🤞

Good luck.👍

Edited by member 22 Jan 2026 at 10:46  | Reason: Additional text

Thanks... It's certainly been a rollercoaster ride (and I'm not a fan!!!). 

Will update you tomorrow

Thanks again for the support and the video of Dr Scholz! 

Francij, I thought the "no clear margins" was a  strange expression and wondered if the "no" could refer to something else. 

Thanks Chris 

Sorry... My bad interpretation! The margins were not clear... Hope that clarifies..?? There is so much medical jargon on all the reports!

agree with frankij1 on this one...especially because you do not want to regret not having done that...

Francij1 and Wife-of-YM. Congratulations, you got it right.✅️

Amelie. I wish your husband the best of luck with his further treatment and hope that he makes a speedy and complete recovery. 👍

As the PMAS scan didn't locate the 'rogue cells' did the consultant say where they were going to direct the radiotherapy? I believe, in cases like this, it's usual to target the prostate bed? 

Edited by member 23 Jan 2026 at 17:53  | Reason: Additional text

Back to Amelie, one more thing I wanted to add is that the radiation (in our case) though rough maybe for a few weeks (it is difficult to recall exactly how long) didn't impede life for so long. Other than the couple of bad weeks where he had to be very careful and was getting up a lot in the night, it was possible to adapt and still have good times and get our heads out of the situation. Each day you know it's getting closer to ringing the bell at the end of the RT.

Thanks again for your kind remarks.

It's often very difficult to comment on treatment, when you are not really qualified to do so. I don't think, apart from a GP who retired years ago, there is anyone medically trained posting on the forum. We once had an oncologist  who posted for a couple of weeks. I think he probably left because he got so many personal messages asking for advice. 😁 He had prostate cancer. I hope he's okay now.

It seems to me, that there are no certainties with any treatment. 

I agree with everything francij1 has said. Me and him, despite us taking the 'urine' out of each other, have been forum mates for 3 years now. I value and respect his opinion (sometimes 😁) As he said, any post op PSA reading of over 0.2 is deemed BCR and would trigger further investigation and possible salvage treatment. It's usually a bad sign, of mets or mirco-mets or cancerous tissue left behind, but as Dr Scholz clearly mentions there are exceptions, where PSA can be caused by benign tissue.

I know Amelie's husband had his consultation today, but I think if I were him, I'd still want to ask his consultant these questions:

How sure can you be that the cause of my PSA is cancerous cells? Could it, because of its fluctuation and decline over the last year be caused by benign cells? It's now only 0.24 could it be less than 0.2 when next tested.  If it drops below 0.2, is it still deemed to be BCR?  It seems to have peaked and is now declining, is it normal for cancerous cells to do this? You say that now is the best time to try and eradicate it. Why didn't you start treatment when it was at its highest 0.32, and it was rising at its fastest from 0.07? Why now, when its declining, when it's dropped by 0.08 from its peak? Why when the PMAS scan is clear, are you considering radiation therapy when there's nothing to target? Why the sudden rush, when nothing suggests there's going to be a sudden progression. What is your reasoning to act now?

Francj1 has stated that the PSMA scan can miss hidden cells in the bladder region. I don't dispute this. But I suggest IF there are any cancerous cells, it's far more likely that there are so few, that they can't be detected.

Dr Scholz states that there is a corelation between the likely sucess of a PSMA scan and post op PSA. There is a 10% better chance of detection for every 0.1 rise. So 0.2 is 20% and 0.9 is a 90%. ( I did a conversation on this with links, but now we've got no search facility, I cant find it! ) Based on this I'd be asking can't we monitor the situation for a while?  Can't we wait and see if my PSA continues to fall, or is it just too risky to delay? Even if, months ahead my PSA rises again, say to 0.5. Could I have another PSMA scan? Which according to Dr Scholz, would give a 50% chance of detection. We might then know if there are any mets, where exactly they are, and could accurately target them with radiation?

It might be that the clinicians have other reasons to act now, but I'd be asking what are they?

All patients have a right to question their treatment plan. Clinicians have a duty of care and should address any concerns you have. If they don't or you're unhappy with their response you can always ask for a second opinion.

Edited by member 24 Jan 2026 at 09:32  | Reason: Typo