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Brief 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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@azp52
Your doctors really missed it. When your PSA hit .1 they should’ve switched to monthly tests. At .2 they should’ve considered you’re getting salvaged radiation, And if it rose any higher, that was definitely needed. Salvaged radiation would’ve taken care of your lymph nodes as well.
Here are the guidelines for when to do salvage radiation and they really show your medical team. Let you down dramatically. Your doctors did not follow the standard of care. You need to find yourself another medical team maybe move to a different place that’s a center of excellence, and get a second opinion on what to do now.
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/