The good news according to Johns Hopkins urologists, including Drs. Patrick Walsh, Mario Eisenberger and Alan Partin among others, is that there is no need to panic if your PSA levels begin to rise after surgical prostate removal. You may not have to do anything for years. Hopkins doctors have developed guidelines to help doctors and patients know what to do if your PSA comes back. On the average it took eight years from the time a man’s PSA first went up until he developed metastatic disease as detected by bone scans or other imaging techniques. Hopkins researchers found that this interval can be predicted using three pieces of information. These parameters include the Gleason score of the pathologic specimen of the removed prostate, the time it takes for PSA to come back and thirdly, how rapidly the PSA is doubling. The guidelines are excellently summarized in the linked article published in the Journal of the American Medical Association and summarized in the Johns Hopkins Prostate Cancer Update.