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Recurrence experiences please.

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User
Posted 26 Apr 2026 at 15:10

Hi. Following up on a post from a while back.

I had an RP in August last year and it appears I'm experiencing BCR.

T3b disease, Gleason 4+5 on pathology. Biopsy suggested 3+4. 6mm +ve margin. Pre op PSA 6.8 No nodes or disease elsewhere on pre op PSMA Pet scan.

First PSA was 0.03, then down to 0.01. Up ten fold to 0 1, now 0.4 six weeks after the previous 0.1. 

I've had a conversation with my surgeon who suspects lymph node could be the culprit and I'm having a PSMA next week.

I'm guessing RT + HT for maybe 6, 12, 18 months?

Has anyone been here with experience to share please?

 

Edited by member 26 Apr 2026 at 16:36  | Reason: Additional information.

User
Posted 26 Apr 2026 at 16:22

Given your pre-op PSMA scan didn't show lymph node involvement and you had a positive margin, it seems much more likely that the PSA is coming from the cancer left behind by the surgeon, than cancer cells which were already elsewhere in your body.  Next PSMA scan will hopefully establish the truth of that.

If the only cancer cells are those in the prostate bed, salvage RT has a high chance of killing them. Quite often SRT is given without HT, your oncologist will be the person to decide what happens next.

 

Dave

User
Posted 26 Apr 2026 at 18:51

There was someone on here recently with a very fast climb, so fast that it's thought to be a false result needing a retest.     0.03,  0.01, 0.1, 0.4 is a fast climb in 8months, and 4x in 6 weeks is as well.   Your pre-op level at 6.8 isn't particularly high.  For a bit left behind to be growing that fast seems unusual.  Knowing the dates might make it clearer, I think I'd be suspicious of the 0.01 and the 0.4.  The first because it's a very sensitive test if it's 0.01 or even <0.01. The 0.4 because it's a fast rise in the short time.  I've had some ups and downs in my tests, you never find out why it's always looking to the next one and what it might be and what you might do.  Good luck,  Peter

Edited by member 26 Apr 2026 at 18:52  | Reason: Not specified

User
Posted 27 Apr 2026 at 06:37
Important to be seeing an oncologist now, the surgeon has had his shot. Get another test to confirm the PSA.
User
Posted 27 Apr 2026 at 13:38

Thanks Adrian. Hope all is well with you.

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User
Posted 26 Apr 2026 at 16:22

Given your pre-op PSMA scan didn't show lymph node involvement and you had a positive margin, it seems much more likely that the PSA is coming from the cancer left behind by the surgeon, than cancer cells which were already elsewhere in your body.  Next PSMA scan will hopefully establish the truth of that.

If the only cancer cells are those in the prostate bed, salvage RT has a high chance of killing them. Quite often SRT is given without HT, your oncologist will be the person to decide what happens next.

 

Dave

User
Posted 26 Apr 2026 at 16:26

Thanks Dave. 

User
Posted 26 Apr 2026 at 17:05

Yes, I was surprised he didn't suspect the area at the margin Dave. I guess we'll soon find out. He did say these are still tiny numbers, and the rate of rise didn't seem to spook him. 

Edited by member 26 Apr 2026 at 19:06  | Reason: Additional information.

User
Posted 26 Apr 2026 at 18:51

There was someone on here recently with a very fast climb, so fast that it's thought to be a false result needing a retest.     0.03,  0.01, 0.1, 0.4 is a fast climb in 8months, and 4x in 6 weeks is as well.   Your pre-op level at 6.8 isn't particularly high.  For a bit left behind to be growing that fast seems unusual.  Knowing the dates might make it clearer, I think I'd be suspicious of the 0.01 and the 0.4.  The first because it's a very sensitive test if it's 0.01 or even <0.01. The 0.4 because it's a fast rise in the short time.  I've had some ups and downs in my tests, you never find out why it's always looking to the next one and what it might be and what you might do.  Good luck,  Peter

Edited by member 26 Apr 2026 at 18:52  | Reason: Not specified

User
Posted 26 Apr 2026 at 18:57

Thanks Peter. Yes, it did surprise me. The surgeon pointed straight to a lymph node in the conversation I had, rather than the prostate bed. I guess the PSMA which is coming up very soon will tell us.

O.03 was a few weeks post op

0.01 three months later

0.1 three months after that, the 0.4 at 6 weeks later.

Our hospital has a super sensitive machine apparently.

Just to add, after an afternoon of research(!)

Short doubling times do indeed indicate lymph node metastasis rather than local recurrence. Just hope it's one or two that can be treated fairly routinely.

Edited by member 26 Apr 2026 at 20:35  | Reason: Additional information.

User
Posted 27 Apr 2026 at 06:37
Important to be seeing an oncologist now, the surgeon has had his shot. Get another test to confirm the PSA.
User
Posted 27 Apr 2026 at 07:11

Thanks for your reply.

My PSMA Pet scan is only a week away now, so oncology will be able to see the result at the same time as the surgeon. Based on your input though, I've messaged the nursing team to question whether oncology are up to date with developments.

User
Posted 27 Apr 2026 at 13:19

Hello again, mate.

I'm so sorry to hear that everything is not appearing to run as smoothly as it should do.

I hope that they identify the cause of the PSA rise and everything gets back on track.

Best of luck, pal.

 

User
Posted 27 Apr 2026 at 13:38

Thanks Adrian. Hope all is well with you.

User
Posted 27 Apr 2026 at 14:12

In your earlier conversation at the beginning of March, I questioned your PSA results and the decision to operate on T3b prostate cancer.

https://community.prostatecanceruk.org/posts/t33273-Recurrence#post314412

In it you stated:

 I was lucky with the surgeon for sure. He wrote to my GP saying the small 6mm margin was a good outcome. 

That mystified me. I don't see how any surgeon can say that a 6mm postive margin is a good outcome? I hope he doesn't turn out to be as 'good' as the very experienced urologist who messed up my treatment.

Sorry, rant over.

Yours, disgruntled, North Lincs. 🙂

Joking apart, mate, like me, I hope things improve.👍

Edited by member 27 Apr 2026 at 15:15  | Reason: Typo

User
Posted 27 Apr 2026 at 15:19

Thanks Adrian.

 
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