PSA rising after prostatectomy - Do I have a recurrence?

[prostateguy]

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I had prostate surgery in 2004 with Seminal Vesicle involvement (pT3b). Surgeon recommended adjuvant radiation but my PSA fell to undetectable ,0.01 so I decided to wait. My last two tests were barely detectable 0.01.

Does barely detectable PSA 0.01 indicate a recurrence, and if so, what are my options?

[Nathan.R PCRI]

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Very low levels of PSA can be produced by the penile urethra or by a little bit of benign prostate material left behind. The traditional threshold for a PSA relapse after prostatectomy is 0.20 ng/dl. Modern ultra-sensitive PSA testing can detect continuously rising PSA from a cancer relapse at a lower level. Some doctors use 0.10 and rising as the threshold. Salvage radiation can be an option in that case. One has to weigh the risks of side effects vs. the chances of long remission from salvage radiation. See the 2010 PCRI article "Nine Decisions Before Choosing Radiation Therapy After Prostatectomy" http://www.prostate-cancer.org/pcricms/sites/default/files/PDFs/Is13-2_p8-17.pdf