Anyone get PSA Test Angst days before that post-treatment PSA test?

I’m on the PSA quarterly rollercoaster too. My last one was elevated so my doctor wants another PSA test sooner than the quarterly test. Last ADT shot was in January and PSA has been undetectable until November when it jumped to 0.3. Live life to the fullest while you can and get treatment as necessary(sucks and lowers the quality of life, but still around to enjoy it)

@yfarah57
Did you get surgery or radiation as your initial treatment?

When Your PSA is rising, even though you are on ADT you have become castrate resistant. Median survival once you are castrate resistant is two years. I became castrate resistant six years ago, The ARPI drugs have enabled me to live longer than the median. I was on Zytiga for 2 1/2 years and have been on Nubeqa (Darolutamide) For three years. I’ve been undetectable for the last 25 months. If you started off with surgery, they can do salvage radiation Which can give you more time, They gave me an extra 2 1/2 years.

If you got surgery and your PSA hit .3 you need to do more than just wait for the next test. If you started off with radiation then, they will wait longer before doing more procedures. A PSMA pet test can show whether or not the cancer has spread visibly in your body.

ASCO, which sets standards for treatment has the following to say if you started off with surgery

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 Have you
been on ADT for eight years or off and on for eight years? Just curious as my oncologist said he might continue to keep me on ADT after radiation therapy.

@jeffmarc

I was initially diagnosed in July of 2023 with a PSA of 29 and Gleason of 8/9. Had multiple scans after the biopsy and they called out cancer in the prostate and two indeterminate spots in the lymph nodes adjacent to the prostate. Started ADT (Eligard/lupron) on September of 2023 and radiation in December 2023 (5 weeks). 6 quarterly Eligard injections (18 month duration) with the last one in January 2025. 68 years old and just retired. Have been feeling energetic the last couple of months as the effect of the ADT diminished and Testosterone rose. Was nice having this ADT holiday

Will be doing another PSA soon and hope for the best. One thing I’m curious about is that my PSA from 12 years ago was 0.55–is that significant in any way—will ask doc the chance I get

Really appreciate your feedback, Jeff, and all the contributors on this forum

A better question might be- Is there anybody out there who DOESN"T get it. I had a prostectomy in March 2020. PSA hit detectable levels in 2023, but still below .2. (that's the cutoff for follow up treatment at MSKCC) . I hit that in Mar.2025 which triggered 6 months of ADT and then 5 weeks of radiation in July. Psa in Oct. ws undetectable, and next test is two weeks. I will DEFINITELY be sweating that one, since the next option is back to ADT , I think.

@bfg1 - To give you some optimism before the next test. Even if it IS detectable , there is a follow up option . ADT and radiation. ( or just radiation) . Not fun, but manageable and highly effective.

@robrite
In 2014 I was on it for six months Because I had salvage radiation.

In March of 2017 I went on Lupron because my PSA started rising after the radiation and I took it until March 2024 when I started Orgovyx.

After seven months of Orgovyx My oncologist and I both figured my testosterone would never come back so I stopped Orgovyx. My testosterone started coming back quickly and after eight months, it hit 50 and my oncologist wanted me to restart due to the stampede trial results. My PSA never did rise because I am on Nubeqa.

So I’ve been on Orgovyx For seven months since then. Little over eight years total not including the six months in 2014.

One big reason I can’t get off of it is because I have BRCA2, And every time I try to reduce the drugs I’m taking my PSA starts rising. Fortunately Nubeqa Works even with some testosterone, But my oncologist didn’t want me to take a chance of my testosterone rising too much.

You do get used to it, I lead a pretty normal life.

@yfarah57 So you started with PSA of 0.55 in 2013 (12 years ago), to PSA of 29 in July 2023. It has been undetectable since after radiation, then it rose to 0.3 after a 10-month holiday off ADT.
After reading Jeff's comment that you replied to, I figured that after surgery, PSA ideally should not hit above 0.2; my previous readings in this forum indicated that it would be a concern if "after radiation and after stopping ADT," the PSA rises 2 points above nadir. Therefore I am a bit surprised that your doctor seems concerned already with your 0.3
But here's the (my) thing: I completed radiation treatment (SBRT) in April 2025, with 6 months in ADT-Orgovyx. I stopped Orgovyx in September; my oncologist indicated that my January 2026 PSA may go higher than my October 2025 PSA, due to my Testosterone level going up by then. But unless the PSA rise could not be explained by a corresponding rise in T, it should not concern me, I was told. After some time that I'm off ADT, my PSA will start going down until it reaches nadir (as late as April 2027 or even later). After bottoming out, it will be a concern when my PSA gets 2 points above nadir (the lowest PSA before it starts going up, e.g., from 0.01 to 2.01).
But your case is different: You were on ADT for 18 months. So maybe it wasn't expected for your PSA to rise 2 points above nadir before it's a concern. This I will confirm with the doctor, if I were in your place. Will your doctor say the rise to 0.3 can't be explained by your rising T (unlike what my oncologist told me)?
But right now, I will not be worried about your case. If I were you.
Regards,

@vircet
While there is sort of a standard set that you wait two points after the low point of radiation, Not all doctors believe in that. The problem is they can’t do salvage radiation if you started off with radiation so what they can do is, when the PSA rises do a PSMA pet test to see if there is any metastasis they can zap.

I have heard in some cases they can do brachytherapy, Something that is not uncommon to do after IMRT/EBRT radiation. Never heard of it being done after SBRT, but maybe I just haven’t heard about it.

Those are a couple of options. Maybe an AI search can show even more.

I also heard of the 2-point spike as the signal to be concerned (from my radiologist and other prostate cancer patient information seminars). My doctor/urologist is very very detailed. Also, I really gave him and his staff a lot of flack for their institutional strategy of stopping routine PSA testing (my pre diagnosis PSA was because I complained to my primary of prostate cancer symptoms). As you may gather, my preference is more PSA testing vs less, and when imaging is needed (I did 3 types last time) I’d rather do it sooner than later