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Low, But Rising PSA--Wait for Imaging or Act Now?
Prostate Cancer | Last Active: 10 hours ago | Replies (46)Comment receiving replies
I kind of just going through this now, 5 yrs after prostectomy undetectable, then PSA starting to rise and at .5 and PSMA PET/CT showed pelvic leasion small and possible left hip, but may have just been bone growth area absorbing tracer. Treated with radiation and PSA undetectable for 22 months with ADT & Bical, then started rising again .11, then .23, then the 4wks later .47 , so rapidly rising doubling every 4 weeks.
Medical Oncologist willing to wait to .5 to see if PSMA PET/CT with Pylarify could pick up anything. Had the scan when PSA was .47 and it showed nothing at all, the prior lesions were totally gone so both my Radiation Oncologist and 2 Medical Oncologist said start treatment with xzanti and continue ADT.
These are some very smart physicians, Harvard undergrad, Harvard Medical School, Professor of Medicine at Harvard, Dana Farber Cancer Research, another one Penn Medical and Yale so I have to listen to what they are telling me and it is a great way to stop worrying about every PSA tic or if I am doing the right thing, that is the biggest challenge.
So my advise make sure you take the time to assemble a top notch group of physicians that you can believe in and focus on fighting this disease and reduce some of the anxiety that we all have.
Reading many post some patients really don't like or trust their doctors, which is not the best situation IMO, get a good team and live your life to the fullest today none us know what tomorrow will bring.
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@gtin723
While putting you on Xtandi Could bring your PSA back down it is not the standard of care most doctors follow. Here’s what the American Society of clinical oncology recommends if your PSA rises after having a prostatectomy. If they can’t find a metastasis using a PET scan, this becomes even more important.
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/
Some doctors want to wait for metastasis to show up so they can zap them. With such a fast rising PSA that seems a little different from SOC. I know I would want to ask my doctor why they are not considering salvage radiation.