What would you do if PSA stayed at 0.15 after prostatectomy?

@jonesfit65 I meant to say on AS.

Thank you for your response. I think in a different way. I can have 3
months. Try to enjoy as we have to fear anything.

With Regards,
Joseph T J.

@josephtj
Great attitude.

Thank you.

With Regards,
Joseph T J.

Hi. I have a different experience. Fourteen years ago my PSA was 92. Had radical prostatectomy. Post surgery PSA dropped to 0.1. Prostate, seminal vesicals, van deferens, portion of bladder all involved. Lymph nodes had 1/17 involved. Final Gleason 5+3. Bone scan negative. Urologist put me on trelstar. Stayed at 0.1 for six years until trelstar lost efficacy (PSA rose to .76 and testosterone from < 10 to 218). Switched to Lupron for four years with PSA steady around .15. Lupron then became unavailable. I was told production issues so switched to Eligard. Saw PSA immediately creep up to .25 but then steady around 0.37 for last 18 months. Maybe the difference of Lupron vs Eligard - IDK? But steady again. Urologist satisfied that there is no danger. I found PSA nomogram doubling tool and it’s -41 years with the last 12 months of data. Over full 4 year scenario of Eligard it’s +3.4 years. I’m now 72 years old. Urologist says stay the course with ADT. He saved my life. Now he just retired. New urologist. It’s 14 years after surgery with the above data. He wants to start back with PET scan. IDK. What to do? Thoughts welcome.

You need to find an Oncologist to work with you. You are beyond the experience of a urologist to really help you properly. Going to a center of excellence and getting treated there could make a lot of sense.

Do you live in the USA? There’s a big difference between Canadian treatment and USA treatment.

Lupron and Eligard are essentially the same drug. They Both use leuprolide. While lupron was unavailable for about nine months, Five years ago it became available right after that and has not had a problem in production since.. No reason to change since they both work the same. Hopefully, you are getting at least a three month shot. I got six month shots of Lupron for six years though for one year it was unavailable and I had Eligard. There was no difference in how they affected me. I switched to Orgovyx About three years ago, It’s a pill you take once a day. The benefit is that when you stop taking it, your testosterone comes back quicker.

2 1/2 years after my prostatectomy, my PSA hit .2 and I was given a 6 Month Lupron shot and two months later had Salvage radiation.

It’s good to hear your PSA has stayed the same. Normally when it starts rising while you’re on a leuprolide it will continue to rise because you become castrate resistant. Frequently they will put you on an ARPI when that happens a drug like Zytiga or One of the lutamides (like Darolutamide). They can bring your PSA back down to undetectable. I’ve had prostate cancer for 16 years and been on ADT for eight years. The last three I’ve been on Orgovyx and Darolutamide And my PSA has stayed undetectable for the last 27 months.

The American Society of clinical oncologist (ASCO0 recommend that you have salvage radiation if your PSA hits .2 after a prostatectomy. In your case, it sounds like your doctor is doing the right thing wanting you to get a PSMA PET scan. That will tell whether or not the cancer has spread anywhere else in your body. Your PSA is a little low for it, but it still works if there is significant spread. If they find it as spread anywhere else, you need to see a radiation oncologist.

Just so you know, here is the recommendation For what to do after a prostatectomy when the PSA rises.

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.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

@jeffmarc

Thank you for your feedback. Since the surgery, we knew that positive margins have left micro amounts of cancer. That has not been in question. The ADT has managed the situation. Yes, agreed Lupron and Eligard are essentially the same. The doubling time is typically calculated based on data over the last 12 months. We have five test intervals that indicate a negative doubling time. Even including the transition time from Lupron to Eligard the doubling time is quite large. With the PSA at the current level of 0.37 the PET scan may not be sensitive enough to tell us more. So we are trying to determine the value added in getting the scan now or continue watchful waiting. In terms of any radiation treatment, we are thinking that since the ADT is holding things in check, do we want to do this now? Maybe one could argue that radiation would drive the PSA back down to possibly not detectable? Don’t know. We have a visit with the new urologist next week. Will want to get his input. Thanks for your feedback.

Most add diagnostic information for context. Gleason 9 plus cribriform in a few pins would have a more aggressive treatment than say Gleason 7 with no cribriform with a few pins. Context adds to the quality of answers to your question.

Here is more detail:

Gleason post biopsy: 5+3
Gleason post surgery: 5+4
PSA pre-surgery: 92
PSA 1 month post surgery: 0.3
PSA 2 months post surgery: 0.1
Lymph nodes: 17 tested, 1 involved
Prostate right lobe: 80% involved
Prostate left lobe: 50% involved
Bottom of bladder: Involved
Urethra: Not involved
Positive margins
Pathologic stage: pT3bpN1MX
Nuclear bone scan: No issues
Started Trelstar 1 month post surgery
No statistics re: cribriform