Well, I hope that some venting alleviated your urge to regurgitate. I will just say straight up that these usPSA tests can drive you bonkers, and that how best to read meaning into fluctuating values in the sub-0.1 world is still somewhat perplexing to me.

I had a RARP in 2015. For the next ten years, my PSA remained undetectable (< 0.1). My urologist never ordered a usPSA test. I was below 0.1, and life was good—end of story. Looking back, I wonder what kind of values the usPSA test would have revealed and how much anxiety (and puking) I would have endured watching numbers bounce around or even trend upward. I’ll never know, but what I do know that is I didn’t fret over my PSA for tens years.

In 2024, my urologist detected a small nodule in my prostate fossa during a DRE. We checked my PSA and it was still undetectable, and so no further action was taken. The plan was to test PSA again in a year.

In June 2025, my PSA hit 0.11. My urologist had retired, and I was referred a new guy who didn’t have all my records initially. At first he was unconcerned, but once he saw my records and realized that a small nodule was detected the previous year, he did a 180 and referred me to a colleague in his practice that specialized in advanced PCa. Next was a PSMA PET scan and a pelvic MRI, both of which strongly indicated that the nodule was a local recurrence. I agreed with my new urologist that a biopsy seemed redundant—the evidence for a local recurrence was compelling enough. Fortunately, scans did not detect any distant mets including pelvic lymph node mets, but then my PSA was so low that the PSMA PET scan probably wouldn’t have picked up any micromets. So, some lingering, small uncertainty there.

Three months later, after opinions from two ROs and one MO, I underwent 38 sessions of IMRT to the pelvic region. Now, here is the Law and Order twist to the plot. I did my first usPSA a few days before starting RT and it came back at 0.094. Huh, below 0.1, not above. And, btw, I did a regular test at the same time, and it again came back at 0.11. Yes, different labs, different instruments/protocols, and different numbers. But if 0.1 is that magic number for “detectability", then the differences were important. If I had done the usPSA earlier that year (when I first came in at 0.11), would any alarm bells have gone off? I doubt it. No PSMA PET scan, no MRI. Just a “you’re below 0.1, see you in a year” send off. So, now the 0.094 value was causing me some anxiety that I might be jumping the gun on treatment. The preponderance of evidence was that the local recurrence was real, but my level of certainty notched down a bit. But, my urologist and RO were still solidly convinced that we should proceed with RT, and that doing so, would increase the odds of successful treatment. Despite my bit of doubt, I was still on board with their recommendations. We moved forward with radiation, and I just embraced that fact that I had this small lingering doubt about my recurrence, brought on by the usPSA test.

While undergoing the IMRT, I asked my RO what she thought of slight variations in usPSA, and whether doubling time even applied in the same manner with values above 0.1. Was a change from, say, 0.042 to 0.051 significant? Was a doubling time of 3 months from 0.020 to 0.040 meaningful in terms of cancer aggressiveness? Her response was “no” unless there was a sustained upward trend, and even then she would not take further action unless PSA hit at least 0.1. Basically, she said that usPSA values commonly bounce around, even for someone like me who had a prostatectomy. She also, said that she didn’t put much stock in doubling times of usPSA values that remained under 0.1. Now, this is all just one RO's opinion, but I think it reflects the fact that different docs may well approach usPSA values differently.

Three months post-RT, my usPSA was 0.086. Marginally better than 0.094 going in, but both my RO and urologist were quite happy with that number. Good chance that it will keep dropping, but if it stays below 0.1, whatever the exact value, then I will consider that a reprieve until the next quarterly test. But, that’s the rationale me. The emotional me misses the “you’re PSA is undetectable (below 0.1)”, see you next time” world. That world is gone.

I’m still coming to terms with the usPSA world, and may well be doing that until the end of my days. Tripping over my cat, falling down the stairs and breaking my neck is probably an exponentially bigger risk factor in my life than a 0.002 rise in my PSA. But tell that to my brain at 3am on a restless night.

So, the moral of this longwinded tale is that yes, usPSA anxiety and vexation is a real thing. Vent away.

And I hope and pray that your husband’s numbers stay below 0.1.