Ah, yes, the prostate specific (ultrasensitive) anxiety test....

With thè introduction of the USPSA test, we ask ourselves, just because we can measure to two or three decimal points, does it necessitate action on our part? It can foretell a treatment decision, but the question is when?

My surgery too was in 2014, "Back in the day" my urologist tested only to a single decimal point so my labs for the first 12 months came back at < .1, "undetectable." Today, would the USPSA tell a different story and if so, would that have changed the treatment decision?

I guess the question is. with USPSA, what, if anything to do, when, with what, for how long...?

From 2014-to 2023 is a long time and a data point that can guide any treatment decision. Other data points include the pathology report, the Decipher test, PSA results which can be used to calculate PSA doubling and velocity times.

As others have suggested, there may be other scans which may show where the activity is.

A question for you, your husband and his medical team may be what clinical data constitutes sufficiency to act? Ig data from imaging is part of the decision process then you may face another decision, how far to let the PSA rise to increase the statistical probability of a scan showing activity? Below .5 a PSMA PET has generally a 1/4 chance, between .5-1.0 it doubles and intuitively, increasers above that. A question to discuss with your medical team may be the risk benefit of letting his PSA rise to whatever point you decide to image. For my medical team and I, we are comfortable with .5-1.0, then image and go from there.

I mentioned PSADT and PSAV because combined with his time to BCR after surgery, GS, GG, Decipher score, a choice may be to just continue to actively monitor:

PSADT
>12 months continue actively monitoring
6-12 months - the grey zone, use other clinical data
< 6 months treatment likely necessary

Surprised but not really that his SRT did not include whole pelvic lymph node and short-term systemic therapy, 6-18 months, but as the old adage goes, water under the bridge...The question is front of you now is what to do?

If you want to be proactive and aggressive, one treatment decision could be whole pelvic lymph node radiation combined with systemic therapy for a defined period, 6-18 months. That systemic therapy could include ADT + ARI. That decision comes with costs, the quality of life, financial, time to go to appointments...

Alternatively, you could do "nothing." Actually, that's a misnomer. You could continue to actively monitor, have criteria about when to image, then decide.

Were I you, what would I do? The latter. The clinical data you describe from my foxhole does not require a treatment decision now.

As always, remember, I am not a medical professional, not trained, educated, licensed or board certified.

Kevin