@billfarm

Yes and no...

A change in PSA is generally "disconcerting" to those of us in this club.

The question is, what to do?
You say labs at Mayo 3/26. My understanding is Mayo only tests and report to a single decimal. So, those labs may come back at < .1. That doesn't necessarily mean it hasn't increased. Also, keep in mind your high school math, if I understand correctly Mayo may report .1-.14 as .1 and when it is .15-.19 report out as .2, rounding up...

I think the real question to discuss with your medical team is what clinical data constitutes a treatment decision?

Will you image? If so, at what PSA, with what agent? If it comes back negative, what then? Keep in mind insurance and financial toxicity of multiple PSMA PET imaging.

Statistically and from intuitive understanding, the higher one's PSA, the greater the statistical probability of the PSMA PET showing where the metastases are, informing the treatment system.

For my medical team and I our "decision" criteria are:

Three or more PSA tests spaced three months apart that show and increase

AND/OR

PSA between .5-1

This assists in acting on trends vice aberrations and a 2/3, roughly, chance of the imaging showing where the metastases are.

We do not feel it risks my PCa getting out of control and becoming unmanageable.

In part, what you and your medical team are thinking about for treatment may drive your decision.

Why?

Well, there is some data that points to MDT only delaying the need for systemic therapy.

If that option is not under consideration and you are considering systemic therapy, doublet, triplet or ARI monotherapy then imaging results may not be a factor.

Discuss with your medical team.

What would I do? Nothing now. I would continue with jabs and consults every three months, when my PSA hit our decision criteria, image and then decide.

That criteria was met in April 2023. We imaged, did SBRT and 12 months Orgovyx. Here we are 20 months after completing that treatment, PSA is stable at .03. My oncologist and I meet today, likely set the next labs and consult for April, three years after SBRT and two after coming off systemic therapy.

Kevin