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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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My urologist said I could start once a year. I am at the 4 year mark so I said no I wanted to stay at 6 months till I clear the 5 year timeline. Even then I may decide to stay at 6 months
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4 Reactions@tjv1156 Interesting how it took 5 years to the month. Even at five years we're not out of the woods! This is good news for you, and potentially good news for me if I go down this path. What was your six months of Orgovyx like? Was it tolerable? Side effects? What lead to your decision to go with Orgovyx rather than Lupron?
@tango32652 my psa started to go over the ‘undetectable’ threshhold (.05) in Oct. , 22. But it didn’t hit the magic number of .2 until feb. ‘25. That’s the number that triggers follow up treatment at MSKCC. Treatment was 6 mos. Of adt and 25 shots of radiation. I chose Orgovyx because it gets introduced more gradually ( daily pill vs shot) . But more importantly, it leaves the system much faster than Lupron. ADT is not pleasant- no getting around it . BUT, it was never as bad as I thought it would be. I got into a good routine of getting up early, yoga/tai chi/ stretching . Then hit the gym for resistance training and/or cardio. There is credible research that shows resistance training mitigates the effects
Of adt. Then a nice nap at lunch time. Fortunately I am retired so I could do this. I had to do it first thing because I found that once my ass hit that chair in the afternoon it wasn’t getting up. Lol
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4 ReactionsI think that all of the comments above are very good and thoughtful.
In reading them, I came to a thought that there is an emotional component to having and treating a disease like PCa.
And the merging of patient fears or beliefs with the medical guidelines in the management of the emotional aspect of disease management is what I see in this helpful thread.
I am conflicted about uPSA testing frequency: 3tbANoMx, G 9 w/EPE, 2 yrs of 3 month testing post SRT, all undetectable.
At my latest annual, I suggested moving to a 4 month testing schedule and received a lukewarm response from the CRNP that the RO preferred a 3 month schedule.
However, and this is the (longwinded point), clearly I have been advised and it is within my control to test every 90 or 120 days. Or 180 if I felt that way.
Paraphrasing @kujihawk1978, what are the risks involved with the decision, and how do you feel about taking on that risk?
I am not sure what I am going to do, but probably lean toward continuing 3 mo testing. I usually only worry about my PSA level after I test and until the results post; so 3 times a year would save me 1 anxious episode, and it would be valuable. However I am not emotionally ready to lengthen my PCa testing frequency, so I will continue with 3 month intervals, in treatment of my G 9 returning phobia.
Best wishes to everyone. I think that the right choice for you is the one with which you are comfortable.
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5 Reactions@michaelcharles
If you are Getting the ultra sensitive tests and you are not seeing your PSA rise at all, then doing four month tests would not be a big deal. Unlikely your PS is going to rise dramatically all of a sudden.
Now the real question is how low is your PSA? Is it below .01? I imagine your doctor would want you to take three months tests if your PSA was a little bit elevated even for the ultra sensitive test like .08 or .09, Even if it isn’t changing.
It is interesting/puzzling that your Doctor doesn’t want you to go to four months test.
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1 Reaction@brianjarvis I updated the wiki page:
https://en.wikipedia.org/wiki/List_of_people_with_prostate_cancer
I underwent radiation therapy for metastatic PC, Gleason 8 (4+4), psa 25. One month after completion of radiation therapy my psa was undetectable (0.006) and six months later it remains there. I get the Eligard injection every 6 months and take abiraterone 250mg and prednisone 5m daily with a low fat meal. When I discussed reducing abiraterone from 1000mg to 250mg, the agreement was monthly testing and if a rise in psa then back to abiraterone 1000mg. Minimal side effects which are easy to tolerate and live life. Follow-up PMSA scheduled for Mar. Wish everyone a successful journey.
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3 ReactionsI am only comfortable with three months. With my PSA rising over the past year, I am doing my next one at the two month range.
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5 ReactionsBrief history: Radical Prostatectomy, May 2020. Original Gleason Score at biopsy was 4+3. Post-RP pathology report was high risk, confirmed 4+3, with positive margins, perineural invasion, and invasion into the bladder neck. No salvage radiation post-surgery. Post-RP, I had PSA tests every 3 months for 2 years. All those tests were < .1. At the 2-year mark, my doctor moved PSA testing to every 6 months until I hit the 5-year mark. About 2.5 years post-RP, just after they moved my testing to every 6 months, my PSA went to .1. About six months later, PSA was up to .78. So, about a year after they decided to move my testing to every 6 months, I was diagnosed through a PSMA-PET scan with lymph node metastasis. Seemingly, the protocol at that time was to test every 3 months until year 2, then move to every 6 months until year 5. One caveat: my testing during the first 2+ years was not ultra-sensitive. Looking back, I wish it had been, as the rise may have been detected sooner. To date, after a year of ADT treatment, the lowest my T-levels got was 179. PSA did go down to .05, but has once again been on the rise; last PSA was .07. Sounds like some doctors are determined to continue the PSA testing protocol: 3 months for 2 years, 6 months till year 5.
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2 ReactionsMy doctor most often discusses "blood supply." He says: "Well, 'if' any cancer cells remained in my body because of my EPE, surgical margins, Cribriform glands, and left seminal vesicle invasion (no tumor or nodule though), those cancer cells would need "blood supply" to survive, and would die quickly without it, AND...I (the doctor) removed any and all blood supply." BTW..he removed both seminal vesicles, both vas deferens, as well as the prostate. I questioned: "But you say that you left my neuro-vascular bundles intact to help with future sexual function, and the "vascular" part of "neuro-vascular" is in fact blood supply???" I never get quite a clear answer from him after that, so I don't know what blood supply he removed during surgery, but how leaving the neuro-vascular bundle somehow is not the blood supply any remaining cancer cells can access. This is especially true since we know that cancer cells "move"...they "crawl" so to speak. Anyone out there have an answer?