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PSA still rising after 10 years+

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User
Posted 10 Apr 2026 at 11:05

Hello

I was diagnosed with low grade PCa in 2013 after biopsies. PSA 4.6. I was put on Active Surveillance. Two years later PSA then rose to 7.5. MRI revealed an abnormality. Biopsies taken and now had a higher grade tumour. 

I had a radical prostatectomy in October 2015. Tumour was Gleason 3+4 and unfortunately small positive circumferential margin. 

My PSA was less than 0.1 after RP. In December 2022 PSA was now detectable at 0.1. In November 2024 rose again to 0.2. Now on three monthly checks. Urologist has said it may be a reoccurance or benign prostate tissue. He said if PSA Rises to 0.3 a PSMA Pet scan would be done.

I haven't seen any reports of benign prostate tissue ten years on, but only just researching. I have seen a PSA of 0.2 after RP could well be a biochemical reccurance.

All in this situation know the level of anxiety awaiting the PSA result. Even more so with it on the rise as it were.

I have a Urology appointment on the 22nd April. Any advice on where to focus and maybe what to ask my urologist would be very welcome :) 

Edited by member 17 Apr 2026 at 16:01  | Reason: Typo

User
Posted 10 Apr 2026 at 12:12

Hello, mate.

Welcome to the forum.

You must feel very disappointed that you've had a PSA rise after all those years of it being undetectable. As you say it may be a very delayed recurrence.

However, the doubling time is two years and the advice of the consultant seems appropriate. If it rises to 0.3 there is, according to the great Dr Scholz, a reasonable chance of locating the the rogue cells, with a PSMA PET Scan. 

Do you mind saying how old you are?

I hope your PSA stays a very low levels and that no  salvage treatment is required.

Good luck.👍

User
Posted 10 Apr 2026 at 20:46
Congratulations on surviving 13 years from diagnosis and 10 years from surgery. Many cancer patients would see that as positive.

As Adrian says the recent rise in PSA looks like a doubling time of 2 years (it would need more data points to be accurate) which would be reassuringly slow for a cancer. Whether it would be consistent with there being some remaining benign prostate tissue I don't know.

As you know PSA of 0.2 is often taken as the threshold for cancer recurrence. However I was told that scans tend to be inconclusive when PSA is less than 0.5 - in my case after it clearly rose above 0.2 (ended up 0.3) I went on the pathway for salvage radiotherapy.

You obviously need to have a serious converation with your urologist in a few weeks, and most likely another with an oncologist in due course.

User
Posted 11 Apr 2026 at 01:11
You need a referral to oncology, a urologist is not appropriate now you have a biochemical recurrence.
User
Posted 14 Apr 2026 at 14:13

Focus on positives as well as negatives. 0.2 is still a very low PSA. It can rise for any number of reasons.  Ejaculations being one of them. Slight infection or anything. 

If it is a worse case and recurrence you are young and healthy and there will be treatment to give you a really hopeful future. I'm sorry your father passed away. But he wasn't treated now and is the past generation. Stay positive and roll with it. All the best 

User
Posted 14 Apr 2026 at 16:57

Originally Posted by: Online Community Member

Focus on positives as well as negatives. 0.2 is still a very low PSA. It can rise for any number of reasons.  Ejaculations being one of them. Slight infection or anything. 

Hello, Antoinette

Brianco had his prostate removed many years ago. As far as I'm aware, he won't have any ejaculations or prostate infections that will affect his PSA levels.

User
Posted 22 May 2026 at 13:41

Originally Posted by: Online Community Member
No of course not. It was a general comment.

I apologise Antoinette. I thought your response was specific to Brianco's case and not about PSA checks generally. My mistake.

Brianco.

We had a conversation on here on when it's best to start salvage treatment. In it, I linked a video from Dr Scholz, who basically said that at 0.3 he thought there was a 30% chance of a PMSA detecting sites of recurrence. At 0.4  it rose to 40%, at 0.5 to 50%, etc, etc up to 0.9 to 90%.

Unfortunately, as we have no search facility I cannot find and link the previous conversation.

User
Posted 22 May 2026 at 19:06

Some 8% or so of men do not express sufficient PSMA for this particular scan to work. In such cases there are other good scans that could be used. Where PSMA is sufficiently expressed, the chances of finding the pockets of cancer increase with PSA along with guide figures Adrian reported by Dr Scholz but these are sort of average. When I sought information on this from Heidelberg University Hospital where with the German DKFZ they originated the 68 Gallium PSMA scan, they suggested I had it at 0.7 but with improved tracers and experience plus greater availability (although the latter aspect is not widespread), some men have had the scan with a few showing cancer spots with a PSA as low as 0.02. As with many things in life, if you pay privately for the scan, you may decide to have it at a lower level of PSA and then again in need,  later when PSA increases. However, the scan is expensive and if you are having it on the NHS, your Urologist is likely to want you to wait until your PSA is higher, depending on the various factors you present, so a more definitive assessment is likely.

Edited by member 23 May 2026 at 07:20  | Reason: Not specified

Barry
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User
Posted 10 Apr 2026 at 12:12

Hello, mate.

Welcome to the forum.

You must feel very disappointed that you've had a PSA rise after all those years of it being undetectable. As you say it may be a very delayed recurrence.

However, the doubling time is two years and the advice of the consultant seems appropriate. If it rises to 0.3 there is, according to the great Dr Scholz, a reasonable chance of locating the the rogue cells, with a PSMA PET Scan. 

Do you mind saying how old you are?

I hope your PSA stays a very low levels and that no  salvage treatment is required.

Good luck.👍

User
Posted 10 Apr 2026 at 14:38

Many thanks

I did mean to put my age, 59. I was 47 when first diagnosed. My dad was 67 when he passed away. His PCa eventually had spread to lungs, bones etc. He wasn't diagnosed until his 65th birthday :(

I probably should've been PSA tested at 40 after he was diagnosed. It never even crossed my mind and no healthcare professional suggested it.

I don't know if the initial biopsies missed my 3+4 but think so. My targetted biopsies after MRI were directly into my perineum.

It may have been contained in the capsule if found earlier :(

Edited by member 10 Apr 2026 at 14:39  | Reason: Not specified

User
Posted 10 Apr 2026 at 20:46
Congratulations on surviving 13 years from diagnosis and 10 years from surgery. Many cancer patients would see that as positive.

As Adrian says the recent rise in PSA looks like a doubling time of 2 years (it would need more data points to be accurate) which would be reassuringly slow for a cancer. Whether it would be consistent with there being some remaining benign prostate tissue I don't know.

As you know PSA of 0.2 is often taken as the threshold for cancer recurrence. However I was told that scans tend to be inconclusive when PSA is less than 0.5 - in my case after it clearly rose above 0.2 (ended up 0.3) I went on the pathway for salvage radiotherapy.

You obviously need to have a serious converation with your urologist in a few weeks, and most likely another with an oncologist in due course.

User
Posted 11 Apr 2026 at 01:11
You need a referral to oncology, a urologist is not appropriate now you have a biochemical recurrence.
User
Posted 14 Apr 2026 at 13:59

I just deal with it as best I can. I tell myself worrying about something we have no control over is foolish. However we are human and I cannot change my nature!

Urology have just contacted me to cancel the appointment. They will rearrange.

The urologist said a PSA of 0.3 for scan visability of any returning issues. 

User
Posted 14 Apr 2026 at 14:13

Focus on positives as well as negatives. 0.2 is still a very low PSA. It can rise for any number of reasons.  Ejaculations being one of them. Slight infection or anything. 

If it is a worse case and recurrence you are young and healthy and there will be treatment to give you a really hopeful future. I'm sorry your father passed away. But he wasn't treated now and is the past generation. Stay positive and roll with it. All the best 

User
Posted 14 Apr 2026 at 16:57

Originally Posted by: Online Community Member

Focus on positives as well as negatives. 0.2 is still a very low PSA. It can rise for any number of reasons.  Ejaculations being one of them. Slight infection or anything. 

Hello, Antoinette

Brianco had his prostate removed many years ago. As far as I'm aware, he won't have any ejaculations or prostate infections that will affect his PSA levels.

User
Posted 14 Apr 2026 at 17:16

No of course not. It was a general comment. Because my husband father had PC in his 70s and recovered ( he died at 93) my husband has had annual PSA tests for quite a while, but this was never flagged up 

User
Posted 22 May 2026 at 11:35

I spoke to my urologist this week. He said stay on 3 monthly checks as still at 0.2.

@Adrian56 You mention Dr Scholz and the PSMA scan detect at 0.3. I looked at his website and saw 0.2 for detection. I don't know if the PSMA scan has the same detection rates in the UK as the US :(

On looking around I saw this:

Detection Rate: At 0.2 ng/mL, there is about a 30% to 40% chance the scan will successfully identify the precise location of the recurrence.

At 0.5 this jumps to 70% and probably somewhere in between for 0.3 to 0.4.

I suppose there is the chance waiting before it rises to 0.3+ it could spread beyond the prostate bed. If that is the site of the recurrence!

 

User
Posted 22 May 2026 at 13:41

Originally Posted by: Online Community Member
No of course not. It was a general comment.

I apologise Antoinette. I thought your response was specific to Brianco's case and not about PSA checks generally. My mistake.

Brianco.

We had a conversation on here on when it's best to start salvage treatment. In it, I linked a video from Dr Scholz, who basically said that at 0.3 he thought there was a 30% chance of a PMSA detecting sites of recurrence. At 0.4  it rose to 40%, at 0.5 to 50%, etc, etc up to 0.9 to 90%.

Unfortunately, as we have no search facility I cannot find and link the previous conversation.

User
Posted 22 May 2026 at 19:06

Some 8% or so of men do not express sufficient PSMA for this particular scan to work. In such cases there are other good scans that could be used. Where PSMA is sufficiently expressed, the chances of finding the pockets of cancer increase with PSA along with guide figures Adrian reported by Dr Scholz but these are sort of average. When I sought information on this from Heidelberg University Hospital where with the German DKFZ they originated the 68 Gallium PSMA scan, they suggested I had it at 0.7 but with improved tracers and experience plus greater availability (although the latter aspect is not widespread), some men have had the scan with a few showing cancer spots with a PSA as low as 0.02. As with many things in life, if you pay privately for the scan, you may decide to have it at a lower level of PSA and then again in need,  later when PSA increases. However, the scan is expensive and if you are having it on the NHS, your Urologist is likely to want you to wait until your PSA is higher, depending on the various factors you present, so a more definitive assessment is likely.

Edited by member 23 May 2026 at 07:20  | Reason: Not specified

Barry
User
Posted 05 Jun 2026 at 10:54

My urologist thinks as it is now four years since my PSA became detectable, may well represent benign prostate tissue. They are still keeping an eye on me rather than discharging me. So staying on three monthly PSA checks. Obviously only the 'gods' know the rate at which a positive margin cell grows, if at all! 

 
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