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Persistent PSA after RALP: 0.22 → 0.20 ng/mL. Looking for similar experiences

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User
Posted 23 Jun 2026 at 22:57

Hello everyone,

I am looking for opinions and experiences from men who have been in a similar situation.

 

Pathology after robotic radical prostatectomy:

pT2

Gleason 3+4=7 (Grade Group 2)

Only 6–10% pattern 4

No extraprostatic extension identified

No seminal vesicle invasion

No lymphovascular invasion

No cribriform pattern

Perineural invasion present

Two positive apical margins:

4 mm

1.2 mm

Total margin length: 5.2 mm

Cancer at the margin was Gleason pattern 3

The report also states:

“Margin involved by carcinoma in area of extraprostatic extension: Not identified.”

 

Postoperative course:

Catheter removed on day 10.

Acute urinary retention 4 days later.

Re-catheterized for 5 days.

Final catheter removal on day 18 after surgery.

 

PSA results:

59 days after surgery (41 days after final catheter removal): 0.22 ng/mL

About 4 weeks later: 0.20 ng/mL

 

So the PSA is still detectable, but it has decreased slightly rather than increased.

My main questions are:

Has anyone had a similar pathology (pT2 + apical positive margins + low-volume pattern 4) with a PSA around 0.2 after surgery?

Did your PSA continue to decline, remain stable, or eventually rise?

Was salvage radiation recommended immediately, or did your doctors prefer to monitor PSA kinetics first?

If you had a persistent PSA around 0.2, what was ultimately found to be the cause (benign residual tissue, local residual cancer, etc.)?

I understand nobody can predict my individual outcome, but I would appreciate hearing from men with similar pathology and PSA patterns.

Thank you very much.

User
Posted 24 Jun 2026 at 04:47
Your pathology seems to contradict itself is it says no extension but then describes a + margin around the extension?

If your PSA stays at 0.2 IE doesn't rise they will monitor it, if it starts to up they will offer further scans and/or salvage radiotherapy.

User
Posted 24 Jun 2026 at 09:20

Hello, Murdoch.

 Following RARP, a PSA of greater than .2 is usually an indicator of possible recurrence. However, there are exceptions where benign prostate tissue left behind can be responsible for that sort of PSA level.

Dr Scholz says those with who have steady low levels can mosey on for years, cancer free. As Francij1 says you will be monitored to see if you're lucky enough to be in that group.

https://youtu.be/JXRhzi0Z6qQ?is=CuaFaW8yVKpTN40d

Good luck, mate.👍

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User
Posted 24 Jun 2026 at 04:47
Your pathology seems to contradict itself is it says no extension but then describes a + margin around the extension?

If your PSA stays at 0.2 IE doesn't rise they will monitor it, if it starts to up they will offer further scans and/or salvage radiotherapy.

User
Posted 24 Jun 2026 at 09:20

Hello, Murdoch.

 Following RARP, a PSA of greater than .2 is usually an indicator of possible recurrence. However, there are exceptions where benign prostate tissue left behind can be responsible for that sort of PSA level.

Dr Scholz says those with who have steady low levels can mosey on for years, cancer free. As Francij1 says you will be monitored to see if you're lucky enough to be in that group.

https://youtu.be/JXRhzi0Z6qQ?is=CuaFaW8yVKpTN40d

Good luck, mate.👍

User
Posted 24 Jun 2026 at 09:35

Thank you for your reply.

I think the wording in my pathology report is a bit confusing. The report states:

“Margin involved by invasive carcinoma in area of extraprostatic extension: Not identified.”

My understanding is that the pathologist did not find any true extraprostatic extension (pT2 disease), but did find two positive apical margins. Both positive margins contained only Gleason pattern 3 carcinoma.

Final pathology was:

  • pT2 Nx Mx

  • Gleason 3+4=7 (only 6–10% pattern 4)

  • Two positive apical margins (4 mm and 1.2 mm; total 5.2 mm)

  • Pattern 3 at the margin

  • No extraprostatic extension

  • No seminal vesicle invasion

  • No lymphovascular invasion

  • No cribriform pattern

  • No intraductal carcinoma

My first PSA at 8 weeks after surgery was 0.22 ng/mL and one month later it was 0.20 ng/mL.

What makes my case difficult is that the PSA is detectable, but so far it is not rising. I suppose the next PSA will be very important to understand whether this is stable residual tissue (benign or malignant) or the beginning of a biochemical progression.

Thank you again for your thoughts.

 

User
Posted 24 Jun 2026 at 09:36

Thank you very much for your reply and for sharing Dr. Scholz’s video.

That is exactly what worries me most: not knowing whether the PSA is coming from residual cancer, benign prostate tissue left behind, or a combination of both.

My pathology is relatively favorable apart from the positive apical margins:

  • pT2

  • Gleason 3+4 with only 6–10% pattern 4

  • Pattern 3 at the positive margins

  • No EPE

  • No seminal vesicle invasion

  • No lymphovascular invasion

  • No cribriform or intraductal carcinoma

My PSA was 0.22 ng/mL at about 8 weeks after surgery and 0.20 ng/mL one month later.

I realize that many men with a persistent PSA eventually require salvage radiotherapy, but what gives me a little hope is that the value has remained essentially stable rather than increasing.

I have an appointment with my surgeon next week, so hopefully I will have a clearer plan soon.

Thanks again for your encouragement and best wishes.

 

 
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