Nearly 20-30% of men who have a radical prostatectomy or radiation therapy for prostate cancer will have a rise in their PSA after treatment. There are multiple options for managing the PSA elevation but they all seem to depend on the answers to three questions:
How long after treatment did the PSA start rising?
How fast does the PSA rise?
What is the Gleason score of the cancer?
If there is a low Gleason score or there is a long delay between the treatment and the first elevation of the PSA and the doubling time of the PSA is greater than one year, then there is not going to be an urgency for manging the rise in PSA. However, for those men who have a high Gleason score, a PSA that starts to increase in less than three years after treatment and whose doubling time of their PSA is less than 3 months, then this is more worrisome and the men are at high risk of increased morbidity and mortality and needs more immediate management.
Radiation can be used after prostate surgery if there is a local recurrence in the prostate gland. This helps a small number of men but is also associated with side effects. Men will have the best response if the radiation begins before the PSA is greater than 1.0ng\ml.
The bone scan can help determine if there is spread to the bones. This test is not useful if the PSA is less than 10ng\ml.
Another form of management is hormone therapy using drugs that shut down the production of testosterone from the testicles. The options of using hormone therapy incude continuous hormone therapy and intermittent hormone therapy where the drugs are used until the PSA decreases and then follow up with PSA testing every month or two then starting hormone therapy again when the PSA rises. Intermittent hormone therapy has the advantage of less side effects from the treatment. The other option is to wait until the PSA significantly rises or that the man becomes symptomatic and then start hormone therapy. At the present time there is no study or consensus of when to start hormone therapy in men with a rising PSA. However, if there is a rapid rise in PSA or a doubling time less than three months, these men need treatment sooner.
Bottom Line: Men have several options for managing the rising PSA after treatment for prostate cancer. There is no one treatment that works for everybody. You need to have a discussion with your urologist or your oncologist.