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PSA recurrence is common. What matters is how we respond to it
You’ve had prostate cancer surgery. Your PSA was zero… and now it’s rising. What’s going on?
It’s one of the most common—and understandably worrying—questions we get:
“If my prostate is gone, how can the cancer come back?”
Let’s unpack this important topic, step by step.
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Why We Still Monitor PSA After Surgery
Even after a radical prostatectomy—where the entire prostate is removed—we continue monitoring PSA (prostate-specific antigen) levels. That’s because PSA should drop to undetectable levels (zero) after surgery.
If PSA rises later on, it’s a sign that some prostate cancer cells might still be present in the body. This is called biochemical recurrence.
What Increases the Risk of Recurrence?
After your surgery, your prostate is examined in detail by a pathologist. We look at:
Tumour size
Gleason score (how aggressive the cancer cells appear)
Whether cancer extended beyond the prostate
Whether it reached the seminal vesicles or surgical margins
These details help us predict if the cancer might return—and if so, where.
Some men are more likely to have:
Local recurrence: cancer comes back in the area where the prostate used to be.
Micrometastatic recurrence: cancer cells travel and recur elsewhere (e.g., lymph nodes or bones).
How We Monitor PSA After Surgery
First PSA test is typically done 10 weeks after surgery (to allow PSA to fully clear).
If it’s undetectable (zero), that’s a good sign.
We continue monitoring:
Every 3 months for the first year
Every 6 months for the next 4 years
Then annually
If PSA rises, we consider:
How quickly it’s changing
Whether it’s a consistent trend
Your original pathology findings
What Happens If PSA Starts to Climb?
If there are high-risk features (e.g., cancer at the margin, outside the capsule, or in seminal vesicles), and PSA begins to rise, we often consider salvage radiotherapy.
This is not immediate—you don’t need treatment after just one rise.
We usually act before PSA reaches 0.2 ng/mL.
You may be referred to a radiation oncologist to discuss your options.
If your original cancer was confined to the prostate, with no high-risk features, we may wait until PSA reaches 0.2 or higher, then perform a PSMA PET scan to locate any recurrence.
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Two Real Examples
🔹 Case 1:
A 65-year-old man had a Gleason 7 (3+4) cancer with extension outside the prostate.
5 years post-surgery, his PSA starts to rise.
Because of his pathology, this man is at higher risk of local recurrence. We’d monitor closely and consider early referral for salvage radiotherapy before PSA hits 0.2.
🔹 Case 2:
A 70-year-old man had Gleason 9 (4+5) prostate cancer that was organ-confined.
If his PSA rises years later, his recurrence is more likely to be micrometastatic. We’d wait until PSA reaches 0.2, then proceed with PSMA PET imaging to guide further steps.
Every Man’s Path is Unique
There’s no one-size-fits-all approach. Your treatment plan is based on:
Your pathology
Your age and overall health
How your PSA changes over time
If your PSA has changed or you have questions about what it means, don’t wait. Talk to your specialist. At the Prostate Clinic we’re here to help interpret the numbers and plan what’s next