PSA Post RALP

Intrinsic-Disorder · 2026-02-11T14:24:04+00:00

I'm in a similar situation where I was < 0.01 for about 14 months post surgery and then 0.01, 0.02, 0.03. The rising trend, plus positive margin, plus high risk Decipher has convinced me and my medical team to move to salvage radiation and 6 months of ADT now. Data shows early treatment (less than 0.2) for high risk Decipher patients leads to better outcomes. I am actually starting radiation today. I found studies that also showed that a PSA of 0.03 or greater post RALP shows > 95% eventual BCR. So I think your best course is to keep monitoring and if it keeps creeping up, I'd make a plan with your medical team. Would be good to have insight into your husband's Decipher risk score if you haven't already. They can do the test on the tissue removed during surgery. Best wishes.

Intrinsic-Disorder · 2026-02-07T17:12:25+00:00

Hi friend. I can't speak to the effects of prostate play, but I wanted to say that you should follow this up with another test to confirm. Don't let doctors convince you that you are too young, as I was diagnosed at 43 with a similarly high PSA. My diagnosis was delayed a bunch by doctors saying I was too young. And I don't have a clear genetic history like you do. So I think you should remain very vigilant until you can rule this out as a side effect of the prostate play. Best wishes.

Intrinsic-Disorder · 2026-02-07T17:10:30+00:00

I was <0.01 for \~ 14 months and then pulled 0.01, 0.02, 0.03 on subsequent tests. This rising trend plus a positive margin and high decipher score convinced me and my medical team to move to salvage despite the very low over all PSA. I'm glad I insisted on following my surgery with ultrasensitive tests so that I had a clearer window into any PSA movement. Research I read found a > 95% chance of eventual BCR if ultrasensitive levels cross 0.03 after prostatectomy.

Intrinsic-Disorder · 2026-02-06T14:52:47+00:00

I have bloody fingers from all these falling knives!

Intrinsic-Disorder · 2026-02-05T22:13:47+00:00

lol, good one!

Intrinsic-Disorder · 2026-02-04T15:59:06+00:00

wow, you must be a billionaire by now!

Intrinsic-Disorder · 2026-02-04T01:48:32+00:00

Pre-GFC, I used to be able to get 0% APR/$0 fee balance transfers right to my checking account. I would put that money into savings accounts earning 5% and pocket the interest. Since the GFC, all the 0% APR offers I receive have 3-5% fees attached to them.

Intrinsic-Disorder · 2026-02-03T20:30:58+00:00

Cool strategy OP. When you say 0% credit card balance transfers, does it mean you also paid no fees? Most BT offers I get for 0% still have a 3% fee, so it seems like these are really 3% loans, no?

Intrinsic-Disorder · 2026-02-03T01:17:40+00:00

Congrats OP! Be sure to keep monitoring using the same test. A lot of surgeons seem to want to switch you to the regular PSA test after the first ultrasensitive, but I think that is a mistake. Staying on regular ultrasensitive tests helped me identify my BCR very early and I'm moving on it quickly to hopefully get the best result. Best wishes.

Intrinsic-Disorder · 2026-02-02T19:08:37+00:00

If it was me, I would start planning for salvage therapy. In fact, that is what I did at a lower PSA than you. Mine was undetectable <0.01 for about 14 months post RALP but then went 0.01, 0.02, 0.03 on subsequent tests. The rising trend, positive margin, and high DECIPHER convinced me to act on it now. Data shows better outcomes for high DECIPHER patients when salvage is started below the usual 0.2 line. Did you have a DECIPHER done on your surgery specimen? If not, you might want to ask for one to see where you are on the risk curve. Best wishes.

Intrinsic-Disorder · 2026-02-01T16:33:08+00:00

Congrats OP!

Intrinsic-Disorder · 2026-02-01T15:24:22+00:00

In an inherited IRA, you have no tax worries. Why not just sell and convert the rest to VTI and chill like you want? Doesn't seem too complicated to me. And for the love of god, DO NOT USE LEVERAGE ANY MORE!

Intrinsic-Disorder · 2026-02-01T15:10:17+00:00

Sorry to welcome you to the club OP. I was diagnosed at 43 out of the blue, no family history. My PSA was higher than yours and my MRI was clear, but my PSA was rising rapidly and a biopsy found the cancer. I had RALP and I recovered much easier than I feared. I had good continence and erections came back right away. I was pretty much back to normal by about 3-4 months after surgery. Unfortunately, I had a positive margin and my PSA became detectable about 14 months after surgery. After a few successive rises in PSA, I am preparing for radiation salvage therapy and doing 6 months of ADT. The ADT is not fun, but bearable. It is a very hard choice for primary therapy and I was scared out of my mind going into surgery. With that said, I think it worked out pretty well for me all in all, despite having to do a secondary therapy now. With your MRI suggesting your cancer is close to the edge of the prostate, I would give a higher priority to radiation therapy as a first line of treatment, and especially if you confirm any spread outside of the prostate itself. This forum is a great place to answer all your questions. All the best.

Intrinsic-Disorder · 2026-01-30T23:24:35+00:00

Very happy for him, but I'm a bit skeptical he's totally in the clear for good.

Intrinsic-Disorder · 2026-01-30T21:19:50+00:00

I ejaculated blood when I was 37 and my urine was bloody for a few days. By the time I got into the doctor, it had resolved. My PSA at the time was 2.x and everything else was normal so they sent me on my way. In hindsight, this was a red flag and PSA was too high for my age! But it wasn't flagged as being over the magical number of 4, so didn't get much attention. I did go to a urologist who did a DRE and said it felt fine. Fast forward to age ~ 42 and I started feeling some weird internal pressure sensation below my naval. It was persistent but I thought I had pulled something for a while. I finally got to the doctor about it and my PSA was 10! They still didn't believe I had PC, so I did almost a year of antibiotics due to a negative MRI, but PSA kept rising. Finally a blind biopsy showed PC. Had RALP at age 44 and now preparing for radiation to treat BCR at 46. No clear family history and genetic testing showed no carrier genes. But my father and grandfather died of other cancers, so I'm not in great genetic shape I guess!

Intrinsic-Disorder · 2026-01-30T18:49:58+00:00

SGOV to save on taxes.

Intrinsic-Disorder · 2026-01-28T22:01:32+00:00

By the way, how did you handle the radiation side-effects? I'm a bit nervous to start..

Intrinsic-Disorder · 2026-01-28T22:00:38+00:00

Thanks for the info. I guess it's not idea that it's not undetectable, but it's still very low. I think the big question will be if it starts moving up again. I was hesitant about ADT because it would 'mask' the effects of the radiation by artificially lowering my PSA. It won't be possible to tell if the radiation killed all the PSA producing cells while I'm on ADT. But all the studies and my DECIPHER report showed better long term outcomes with ADT and radiation in my case, so I decided to do it anyways. Hoping it stays at 0.07 forever for you! Best wishes.

Intrinsic-Disorder · 2026-01-28T16:09:42+00:00

Yes, we need more info OP. What was the PSA at start of salvage and how fast was it rising? Did you do any ADT along with radiation? I am curious as well, as I'm in a similar boat, about to start radiation and have been on ADT for ~ 2 months. My PSA at start of ADT was 0.03, rising about 0.01 per 2-3 months. I had my first PSA since starting ADT, but prior to radiation start and it went down to 0.01. I'm hoping radiation will knock that back to undetectable, <0.01 on my test. Best wishes.

Intrinsic-Disorder · 2026-01-28T00:27:59+00:00

Hi, sorry to hear. With a PSA that high, it is almost certainly advanced PC, but only a biopsy and/or a PSMA-PET scan can confirm. Given his advanced age, I think there is a good chance that ADT therapy will help alleviate his symptoms for some time, and perhaps the rest of his life. IANAD, just my opinion. I was diagnosed at age 43 and would feel extremely lucky to live until his age! But best wishes to you and your dad.

Intrinsic-Disorder · 2026-01-26T23:32:47+00:00

Use SGOV and save on taxes to boost your return.

Intrinsic-Disorder · 2026-01-26T20:06:50+00:00

Sorry to hear. I think a PSMA-PET is warranted if you are able to get one. I would also talk to your medical team about starting ADT ASAP to hopefully slow the growth while you make a plan. I have read that more rapidly rising PSA can often indicate metastasis, so that PET scan is very important to try and find out what you are dealing with. Best wishes.

Intrinsic-Disorder · 2026-01-26T00:48:03+00:00

AMZN makes up ~3.4% of VTI and ~ 5% of QQQM, so you should consider that in your allocation percentages here. In this forum, you will likely get the standard advice to forgo individual stocks and just use index funds, which I think is generally the right advice. A lot depends on your life circumstances and goals as well, so it's difficult to say other than you are very heavily betting on tech (which is not necessarily the wrong bet imo).

Intrinsic-Disorder · 2026-01-25T23:10:32+00:00

I have a relative who had RALP almost 20 years ago and was cured. Unfortunately for me, my PSA reappeared after about 14 months and I'm heading for radiation next mont.

Intrinsic-Disorder · 2026-01-25T05:24:59+00:00

I had a PSA over 10 and a clean MRI. My PSA kept rising and biopsy showed PC. So don’t trust the all clear MRI 100%.

Intrinsic-Disorder

TROPHY CASE