PSA detectable 18 mos after prostatectomy

Me hicieron la PR en mayo 2020 . Mi PSA después de la operación fue de 0.03. Cada 3 meses me hacía exámenes y ellos mostraban un aumento pequeño pero constante hasta llegar a 0.5 . Los estudios determinaron cáncer prostático grado 4 con metástasis ósea. En el 2023 luego de 6 sesiones de radioterapia y un tratamiento hormono depresivo mi PSA es de 0.00. Lo primero: No se alarme. Las fluctuaciones de valores pequeños pueden tener varios motivos sin que sea alarmante. Trate de que su marido se haga exámenes más frecuentes y si el aumento es constante, hablé con su médico a ver qué opciones recomienda. Que la salud les acompañe.

I have a different perspective now being a patient myself: post-RP, Gleason 3+4=7 (only 6-10% "4" cells) with EPE, surgical margins, cribriform glands, and slight invasion of my left seminal vesicle (pT3b classification), but I was in in the clinical laboratory field for 40 years, and there is something we refer to as "clinically significant" when comparing two test results, or one result that seems to be an outlier to a group of test results on the same patient.
Generally speaking, +/- 10% difference in values is not "clinically significant." Normal, expected variation in the performance of the instrument or technologist when it's a non-automated, manual procedure, is not cause for alarm. That test could be repeated, and be back aligned closer to the previous test values, just by shear inherent method variation and test performance bias. If you had enough of one sample, you could run that specimen, say 10 or more times consecutively at the same time, and get 10 or more different values, but the difference being clinically "insignificant."
I am Diabetic. I run two tests every morning and every evening. They are NEVER the same value on my meter. One might be 110 and the other 116. The difference of 6 as a percentage of 110 would be clinically "insignificant." If one was 110 and the other was 128, that would be clinically "significant" and warranty repeat testing, and perhaps other investigations if that variability continued between each test value. That's why labs runs calibration of the instrument and control samples to ensure method and test performance stability. Each test has its normal reference range in accordance with the method and that method's accuracy (closeness to the true value) and precision (reproducibility). There are quality control method rules that every lab follows to guarantee efficacy of the test method.
"That said"...a value of 0.1 ng/ml and 0.14 ng/ml is actually a 40% difference, and therefore will likely be considered "clinically significant" by the urologist. The math is obvious: the smaller the value, the greater any seemingly "small" incremental increase might seem insignificant, but that 0.04 ng/ml increase from 0.1 to 0.14 will likely be considered clinically significant. For those wondering why the physician wants to start radiation or other therapies as soon as you hit 0.2 ng/ml, after several < 0.1 ng/ml, think about it: you might say, "but it is only 0.1 ng/ml higher than the last value", but...that 0.2 ng/ml is a "100%" increase...it doubled from 0.1 to 0.2, .since the previous measurement. Hope this helps.

I just want to make sure that this comment is clarified, because it is not at all true:

" ...but I am also reading that early BCR with doubling rates < 6 months puts 5 year survival at < 20%. "

This would be more accurate:

Research has shown that while a short PSADT is a negative prognostic factor, the 5-year survival rate is not as low as the statement suggests. Several studies have shown that for patients with BCR and a short PSADT, the risk is more focused on the development of distant metastases and a shorter time to death from prostate cancer, rather than a low 5-year overall survival. A large-scale analysis of men with BCR after prostatectomy found that those with a short PSADT had a significantly increased risk of developing distant metastases, but the 5-year metastasis-free survival was still well over 50%.
Additionally, the overall cancer-specific survival for men with biochemical recurrence is generally quite high, with some studies reporting 10-year cancer-specific survival rates of over 90% after salvage therapies like radiation. This shows that even with a high-risk feature like a short PSADT, many patients can still have a good prognosis due to effective follow-up treatments.

Following up on that very comprehensive analysis by @smoore4 I would ask your team about ADT (Orgovyx) in conjunction with another type of T receptor blocker.
I am not a RO but your pathology - and subsequent post surgical PSA - suggests a more aggressive cancer; you would probably benefit by having the both the T spigot turned off AND the T receptor cells on any PCa cells outside the prostate blocked.
A recent post pointed out that T is produced in the gut in men on ADT, so even if your own natural T production is suppressed by Orgovyx or Lupron, other metabolic pathways can arise to produce it.
Phil

And they are watching the velocity too. 2 years post RP I went BCR and the adt and radiation. Currently in the waiting period for my first post combo test in September. Rolling with my increasing energy and living my best life until then.