Rising PSA after a Prostatectomy - any advice? Do I need radiation?

I had a very similar story.  Radical prostatectomy in 2002 at age 56, PSA recurrence in 2009.  In 2010 had salvage radiation to the pelvic floor area.  That failed and I have been doing various treatments since.  I WOULD NOT recommend the salvage radiation.  There are other, less potentially damaging modalities.  Your very low PSA means that the cancer is at a cellular level and the chance of catching every cell is probably low.  The radiation created severe bleeding in my bladder, which still comes and goes despite 50 hyperbaric oxygen\n treatments.  Salvage radiation is EBRT.  SBRT, stereotactic beam radiation can be used very effectively down the road when you develop actual tumors.  Get to a good oncologist who SPECIALIZES in metastatic PC.  As I said, there are some good options other than salvage radiation.  I am currently doing Zytiga, an oral chemo. with little or no side effects.  Hormone therapy (ADT) is also probably a good idea.  Steve

My story is also similar. Radical prostatectomy robotically in 2008 at age 60. In 2017 began getting urinary tract infections. Was eventually diagnosed with recurrence of prostate cancer. Went through 6 months of chemo (Taxotere). PSA values were knocked down to <0.02 following chemo. Chemo ended in November 2017. After a few months PSA values began to slowly increase. In June 2018 it was 0.04. Small tumor found at the apex of the bladder. Biopsy confirmed cells were prostate. Tumor continue to enlarge and was removed robotically March 6, 2019.

PSA values after June were: October 9, 2018 - 0.035; February 12, 2019 - 0.88; March 26, 2019 - 0.28 and finally May 14, 2019 - 1.04 ng/mL. Began taking Zytiga yesterday. So far no side effects. Been an hormone therapy (ADT) since July 2017. Was set up to do immunotherapy at the John Theuer Cancer Center in January 2019 but passed out due to pain in left wrist and did not continue with procedure.

I did Provenge immunotherapy last year before starting Zytiga.  Not sure if it helped or not, but it is a very difficult procedure.  I would not want to do it again.

@slschmidt7748 

How long have you been on Zytiga and has it had an effect on PSA value?

Zytiga has worked very well for me.  I started on it September, 2018, so I’m 8 months in.  PSA has declined every month since I started.  Now 3.48, down from 80 last September!   I’m also getting monthly Firmagon (hormone therapy) shot and Xgeva shot to strengthen bones.  

I’ve been on androgen deprivation therapy at the outset when reoccurrence was diagnosed (July 2017). I get 4 injections per year with Eligard and 2x/yr with Prolia to strengthen bones. I’ve also had 3 bone scans, most recently May 6. Fortunately bone scans have all been negative. A CT scan also from May 6, did not show anything remarkable. It is my hope that this currently incurable disease is progressing slowly and that my Zytiga therapy will continue to keep it at bay.

I am glad to hear that Zytiga is working for you. Have you experienced any side effects?

Glad  to hear your bone scan is clear.  I have significant bone mets, but they have stopped growing due to the ADT and Zytiga.  No real side effects from the Zytiga and all my CBC and CMP values are good.  Stay well and strong!

Been on Zytiga for almost 2 weeks with no side effects. Have noticed less stiffness in my hips when I get up from a sitting position and feel generally well. I suspect that the 5 mg Prednisone 2x/day is probably the reason. Walk at least 5 days/week for 1 hour. No shortness of breath. Been walking for a few years. I was also diagnosed with IPF (Idiopathic Pulmonary Fibrosis) in November 2017, was put on Esbriet but had to stop due to severe allergic reaction. No longer taking lung medication and not having any symptoms. Will have CBC & chemistry done next week to make sure the liver is not compromised.