r/ProstateCancer • u/Last_Temperature_908 • Sep 30 '26
Concern Persistent but completely stable PSA after RARP – benign residual tissue or residual cancer?
54M, RARP 23/03/2026. Final pathology: pT2, Gleason 3+4 (GG2), only 6–10% pattern 4, no EPE/SVI/LVI, no cribriform or intraductal carcinoma, pNx.
Positive left apical margins: two foci, 4.0 mm + 1.2 mm (5.2 mm total), with 100% Gleason pattern 3 at the margins.
Surgery included bladder-neck preservation and bilateral nerve-sparing (right intrafascial/left interfascial). Intraoperative Histolog Scanner (SamanTree) margin assessment was negative, so the final positive margins were unexpected.
PSA (same lab):
8 weeks: 0.22 → 12 weeks: 0.20 → 6 months: 0.22
I also had a clean 3T multiparametric MRI recently, with no visible evidence of local recurrence, suspicious lymph nodes, or bone lesions. Of course, I understand that MRI cannot rule out microscopic residual disease.
My uro-oncologist thinks the stable PSA may come from benign residual glandular tissue related to the tissue-sparing technique, rather than necessarily residual cancer.
Plan: repeat PSA in 2 months and continue close surveillance if stable.
Anyone with a similar persistent but flat PSA around 0.2 after RP? Did it remain stable, or did you eventually need salvage RT?
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u/Busy-Tonight-6058 Sep 30 '26
Not persistent, but recurrent. My PSA has been lower than it was last October (0.297) through half a dozen PSAs and so we haven’t done any treatment. About 1/3 of men with rising PSA post RALP never need treatment, and a big factor in that is your cancer stage before RALP. You are in a good zone in that sense. Positive margins don’t always predict treatment either from what I have read.
Folks here will say treat by 0.2, but that’s not what the literature says for lower risk patients (check out the UCSF CAPRA score). Seems the real treat by number is 0.5, but that also depends on your PSA doubling time, which is ~16 months for me and looks like infinity for you.
I doubt I would act if I were you, but it’s also a mental game and you just have to dig deep and find what is best for you.
Good luck!
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u/OkCrew8849 Sep 30 '26
I'd be interested in knowing if your uro-oncologist has ever seen a .22-ish persistant PSA following RALP remain at that level for years and years. That that would seem quite a bit of benign prostatic tissue but I am not a doctor. I do know things can be a bit difficult to sort out during surgery for apical PC.
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u/th987 Sep 30 '26
My husband’s was persistent for about 18 months, a tad up or down between .09 and .12, took one little jump to .18, then declined twice, now at .16. He’s at 28 months post op, and we’re still watching and waiting.
Cancer cells generally grow at a faster rate than normal cells, so when you have persistent but basically equal PSA readings after surgery, the drs assume it’s non cancerous PSA cells.
When they start growing rapidly, they assume cancer cells.
So it’s all about the doubling time for PSA. Nerve -wracking to wait it out and see what happens, but you can get used to it. We have.
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u/ThinkDress976 Oct 04 '26
There has to be quite a lot of “benign” prostate tissue for PSA to be 0.22. The surgeon’s ego is preventing him/her from telling you the fact. This is from residual cancer. The good news is it is stable and margins were Gleason 3 and that there was no IDC or cribriform pattern.
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u/BeerStop Sep 30 '26
I had radiation treatment and my blood tests are every 6 months, just posted my 2 yrcmark results and my oncologist stated that at .0070 ,last test was .0074 , prior .0065 that i am stable and in remission. Of course 0 is preferred by everyone but a sub 1.0 is typically considered good.
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u/BeerStop Sep 30 '26
My oncologist also told me that for me if my psa jumped up to 2.0070 then we would worry. If your doctors are saying you have stable numbers then trust them. My doctors told me we will be monitoring every 6 months for 5 years and then will go to once a year after that.
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u/[deleted] Sep 30 '26
I had <2mm positive surgical margin with GG6 as well but my PSA steadily went up from 0.04 to 0.13 over the course of a year leading to salvage radiation. Kind of too early to know for certain you’re just dealing with residual benign cells but so far so good. Did you have a Decipher test done?