PSA = 0.02 on second post-op test

It’s 0.19 Ugh!

Hello, I’m not sure why the period was not included. It’s 0 period 19 Thanks for your support.

Yes, I had a prostatectomy. My Gleason was a 3+4 =7
Cancer was also found in one lymph node.

A Gleason 3+4 Is a nice number to start with, But the fact that it had already spread to one lymph node could means that it is in the bloodstream.

Don’t freak out, You still have a very mild case. You could have salvage radiation and it might resolve the problem.

You could see if your doctor would let you get a PSMA PET scan even though your PSA is quite low. Maybe you can find somewhere else that has spread that is not in the area that you would have salvage radiation. Doctor at PCRI conferences say that salvage radiation doesn’t hit the right spot in about 2/3 of the cases and That zapping it with SBRT is a preferred method.

What kind of doctor are you working with? You are now beyond the expertise of a urologist, You should be working with a radiation oncologist to start with and also a Genito Urinary Oncologist To try to guide your treatment. You could wait one more PSA test to see if your PSA continues to rise. If it does, as you can see from the other information I provided, you don’t want to wait too long And allow your PSA to get too high before treatment.

I had a prostatectomy 15 years ago and 3 1/2 years later it came back. I had salvage radiation and two years later it came back, Went on Lupron at that point. I was 4+3 with BRCA2 And I’m still around.

Thanks for your input. It was really helpful! I’m seeing a local family doctor. I’m also sending my lab results to the Mayo Clinic. They are monitoring this. 😊

Aah, the dilemma of USPSA..

We fret overt every lab and the sensitivity of labs make it even more interesting.

At my last consult my oncologist said "Kevin, your PSA has been stable the last 14 months, see you in four months.

We have decision criteria in place to decide about if to treat, when...

Those criteria are:

Three or more PSA tests spaced three months apart with an increase in each one.
PSA between .5-1.0

Why those?

Given variability of PSA at ultra low levels, want a confirmed upward trend.

We want to image before deciding on treatment.why, to inform a decision. We know you can image below .5 but feel our odds are better with our criteria, of locating recurrence, 2/3 vs 1/3.

My medical team and I are comfortable with the risk benefit tradeoff of our criteria.

The definition of BCR is generally understood for after surgery or radiation when we use a test to a single decimal point. Mayo still uses the single decimal test I believe. With the introduction of two decimal points, that accepted definition and understanding of BCR is not so "clear."

Our dilemma is one of if, when, with what, for how long. There are a lot of variables that go into that, some are science.

GS
GG
PSA
PSADT
PSAV
Pathology Report from surgery
Biopsy report

Others are qualitative.

Financial toxicity
Desire to avoid or minimize side effects
Quality of life

There is the science, guidelines such as NCCN and AUA. As I've said, those tend to lag behind medical research from clinical trials and studies and are population based.

So, we start with the science, then apply it to our specific clinical data, the art.

You have choices, good choices. Is there one "right" choice, likely not. You can use up valuable brain space sorting through all the possibilities and trying to decide.

What would I do were I you with the clinical history you describe? Nothing. I would continue to actively monitor with jabs and consults, discuss with my medical team about what clinical data may constitute the call for action, then discuss and decide.

For now, I would do nothing, enjoy my life,

Kevin