PSA = 0.02 on second post-op test

I think that still has in you the "undetectable" range and may only signify a testing variance, perhaps calibration. Hopefully it's not anything to be concerned about.

A PSA reading of 0.02 would be "undetectable" on the normal PSA test, as @survivor5280 pointed out, but you must have had the ultrasensitive test (the same as I get), which gives you much earlier warning. That's a mixed blessing: you have more time to respond, but also more time to worry. 😢

I think they'll keep watching now to see what happens: does your PSA stay in the very low (but detectable) range, or continue rising? Some of the options they might offer now or in the future will be hormone therapy (if you're not already on it), salvage radiation (to catch any localised cancer the prostatectomy might have missed, like the bladder-neck invasion), genetic testing, and additional imaging. But your PSA is still extremely low, so you might not need any further interventions for years. 🤞

Best of luck talking with your onco!

It is great that your first post-op PSA was undetectable. Now you have another data point and will get another data point in 3 months. Your PSA level is far below biological recurrence trigger point of 0.2, so no action warranted, other than continuing to physically recover, treat your body well with exercise and diet, and enjoy every day to the fullest.

Best wishes for a great summer

Much ado about nothing. Your PSA would have to rise 10 times before you would even be considered for treatment. PSA tends to rise and fall for many people, I was on Zytiga for 2 1/2 years, In that time, my PSA was undetectable only one month. The rest of the time it was between .2 and .7, Each month would be different And some months I would go from .7 down to .2, not a time to panic.

Your doctors going to just have to explain how this rise is insignificant.

Over at the advanced prostate cancer weekly Ancan.org meetings We have people come in sometimes with similar results of their PSA, test panicking about a rise that is essentially meaningless. Your PSA can go up and down while on the drugs. You may find that next time you get tested that it’s less than .02.

I intentionally don’t get the ultra sensitive test because of exactly what you are going through. I’ve had prostate cancer for 15 years. I’ve had four reoccurrences right now I’ve been Considered undetectable at < .1 for 19 months. If I had the ultra sensitive test, I might see my PSA going up and down every month, But there is no benefit to having that, I just need to know if my PSA rises to .1 or above.

I think the OP's point is that after a prostatectomy or radiation, as long as your result is "undetectable," you can cling to at least a faint hope that the cancer is gone forever.

As soon as you have *any* detectable PSA result — even an ultra-low one like 0.02 — you have to admit to yourself that the cancer is still there, even if it's not doing much right now (and may not for many, many years, if ever).

It's not about the clinical result, but about grieving and acceptance. My brain knows that I'll probably get a "detectable" result again some day (I'm at almost 4 years, which is a long run for castrate-sensitivity), but my heart still hopes my PSA will stay undetectable forever, even though I know there are lots of excellent treatment options once it starts rising again.

Don’t sweat it! You only need to do that if your next 3 PSA’s show a consistent rise higher than the previous one.
You can then get the PSA velocity, which, if significant enough, may prompt your docs to start you on salvage therapy before the much heralded 0.2 is reached.
Hopefully, that will not be necessary; with a G4+3 unfavorable, I was at 0.02 for almost 2 yrs before the PSA even budged. But with a G9 you have to be ready with a plan of action.
Phil

Hello, I’m getting ultra sensitive PSA tests. I have been for three years. My last test came in 0 19. I’m concerned.

I'm sorry to hear that. It's still a very low number. Thry probably won't do anything yet, but if it's been on a consistently rising trend, it wouldn't hurt to start discussing possible future interventions, including new imaging, ADT and an ARSI (if you're not already on them), etc. I hope your next chat with your onco goes well.

Did you Have a prostatectomy? If so, it is recommended that you get treatment when you hit .2 and at this point, you may be where you should get treatment now. Check out this information about what happens if you don’t get treatment soon enough.

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

Just realized you left out the period.

Is your PSA .19 or .019?

If .19 what I wrote applies.

If .019 you have nothing to do yet, actually a good number to just be aware of.