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Postop pathology to ChatGPT & asked about BCR. Anyone done this?
Prostate Cancer | Last Active: Mar 4 9:14pm | Replies (36)Comment receiving replies
I got similar advice from ChatGPT just last week (also one of the few times I've queried that source), which I take with a large grain of salt but which will guide my questions at next meting with the doc at Mayo on 2/3/26.
My biopsy on 8/26/25 showed Gleason 4+3, intraductal, large cribiform & extracapsular extension. My radical prostatectomy on 10/29/25 (with several pelvic lymph node removed) showed Gleason 4+5, intraductal & extracapsular extension. But surgery showed negative margins and no cancer found in lymph or seminal vesicles. I had a PSA of 8.4 before surgery, and PSA of 0.23 thirty days post surgery. I assume the 30 day number is residual. Will have 90 day post surgery PSA on 2/3/26 & will discuss adjuvant radiation vs. very early salvage with my surgeon at that time. Will also try to get appointment with an oncologist to get a wider perspective.
I talked with a local radiologist who said he does not recommend adjuvant radiation & said I should get back to him if two PSA readings of 0.2 or above. ChatGPT said early salvage at 0.02 PSA (So, some conflict between 0.2 and 0.02 threshold, which could just be someone's typo). Assuming ChatGPT is at all correct, I am considering adjuvant radiation (if medically approved) out of concern that there might be significant delay between a detectable PSA and commencement of very early salvage. But early days.
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@tomsaville
You did have the PSA test a little early, but I would not want to wait until February For the next test. Normally the first test after surgery is done around seven or eight weeks. At that point PSA should be undetectable. If it’s above .2 that’s a problem since there’s something hanging around besides the prostate itself. You did have clear margins so it sounds like it’s not that specific area but your first PSA is definitely a little high. A PSA test right now would be about the right time to find out whether or not you really are undetectable. That could really give you an answer as to whether you need further treatment. Waiting till February could be a mistake if your PSA is rising. Ask your doctor about getting the next test now, not in February.
It is possible you could get a PSMA pet test To see if there’s spread somewhere else in your body. If the next test is higher, the pet test would Give real useful information.
ASCO American Society of Clinical Oncology, the world's leading professional organization for cancer doctors doesn’t recommend salvage radiation at .02 but at .2 it is highly recommended.
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/