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Frequency of PSA Test
I just had my two year-post RP PSA test, and it continues to show undetectible. This is especially good news because I am high risk- Gleason 8, Decipher .91, and the path report was worrisome including positive margin, although I had no metastasis when I was diagnosed and the genetic test I had was negative. They did, however, remove a bunch of other stuff including the bundled nerves, lymph nodes and seminal vesicle to help prevent potential spread as those are all known potential landing spots for microscopic cancer cells left behind. Up until now I've been scheduling PSA tests every three months. My doctor now says I can go every 6 months. I responded by actually asking that we keep it at three. I'm kind of scratching my head over this one. Everything I see shows that it really takes anywhere from 3 to 5 years worth of PSA tests, post RP and without a rise in PSA, to know that you are out of the immediate danger zone. Of course, that could change in years 6 or 7 or even years 10 or 15, but your BCR odds seem to plateau after that long and less frequent PSA tests are indicated. I am wondering why they would recommended I now go an every 6 months cycle so early in the game?
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@brianjarvis Are you in 6 month cycles now? May I ask if you recall what your Gleason score was, and did you have RP or radiation treatment after diagnosis? 5 years is great to hear. It can happen, but definitely not the norm so you are among the luckier ones (about one in four I believe, according to the data, for aggressive non-metastatic disease).
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1 ReactionEvery 3 months for me since my RARP in May of 2025 and this schedule will continue for at least 2 years.
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1 Reaction@tango32652 We just had my first 6-month PSA test in December. (I’ve tracked all my PSA tests; see attached.)
My Gleason at the start of treatment was 7(4+3); I had 28 fractions of proton beam radiation (during April-May 2021) + SpaceOAR Vue + 6 months of Eligard.
I listened to a recorded webinar last week where the urologist mentioned, “following primary radiation…..if a patient has not experienced a biochemical recurrence by 5 years, the chance of developing a distant metastasis after that across all risk groups is only 3%”.
So, my next PSA test (in June) will be just after the 5-year mark.
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3 ReactionsHow much does a PSA test cost in the U.S.? In Canada, if I paid for it myself, it would cost about US $30, less than a takeout meal from Uber Eats. It's a non-invasive test (just drawing blood), and the only person you have to see is a phlebotomist for 5 minutes.
Seriously, why are any doctors recommending skimping on this, other than to avoid inconveniencing patients who find it hard to get to the lab? Does the test cost insurers a lot more in the U.S., like prescription drugs do? If your cancer does come back and you don't catch it early, it will cost the insurers hundreds of thousands of dollars in treatment, at least.
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2 Reactions@brianjarvis
Congrats as you approach the 5 year anniversary of your primary treatment! Sharing PCa journey data is very helpful for those of us who opted for RT or RT + ADT. I started lupron + abiraterone in 3/2022 and proton therapy in 6/2022. My psa has been < .03 until last August when it was .04. In November it was .05 and in December .03. While knowing that PSA > .03 is normal and expected with RT as primary therapy, being a Gleason 9 with cribriform and EPE, having a measurable psa for the first time wasn't a positive experience. For me to be able to see small changes from test to test in your data is reassuring. Thank you!
If you have a link for the webinar you mentioned, I would appreciate your sharing it.
Wishing you all of the best.
Bill
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1 Reaction@dailyeffort The webinar —> managing biochemical recurrence following prostate radiation: https://youtu.be/xZYMTRjKI9U
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1 Reaction@northoftheborder Where I live (Ohio, U.S.), self-ordered PSA tests are $40. During certain times of the year - like around Father’s Day - they lower the price to $25 - $30.
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3 ReactionsAs of the 31st of this month, I'll be 3 years out since my RARP. Pathology downgraded my initial diagnosis from Gleason 8 to 7. My PSA has been undetectable since, checked every 6 months
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1 Reaction@brianjarvis So about the same as here in Canada (it's free if ordered by a doctor, but costs US $30 and up if self-ordered).
It's absolutely inexplicable that doctors would be reluctant to order that either for annual screening, or for frequent monitoring after a cancer diagnosis.
Women have to put up with what feels like having their breasts crushed in a vise for mammograms, or sandpaper scraped inside their vaginas for pap smears; all we have to worry about is a tiny needle poking into our arms (and they can draw blood for dozens of other tests at the same time).
@tango32652
I did not have RP. So most of your post I can add anything with my direct experience with RP and the appropriate PSA testing.
However, I had 30 rounds of proton radiation. I had the every 3 months PSA test until got to 2 year mark. At that time (UFHPTI) wanted to move to 6 months. However I am a patient at Mayo Jacksonville and my PCP and I discussed this and we decided we would go it every 3 months.
So like you posted sometimes I think mental health with this is a major factor and I like the every 3 month. When you have your PSA test do they use the standard PSA test or the ultra sensitive test? Some labs do one, some do both, and some only one type.
Are you taking hormones? I also can't add experience with this but know from other posters that being on hormone treatments has a lot to do with PSA testing results. I know we who still have a prostate should have PSA and completely normal to have it. With RP I think the undetectable level is what you and your urologist are looking for versus the acceptable levels of PSA when you still have your prostrate.