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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
@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.
Replies to "@gtin723 While putting you on Xtandi Could bring your PSA back down it is not the..."
Yes, every single study showed those results and they were done on thousands of patients and were randomized.
I am yet to find and TRUE randomized study that shows that waiting for lesion to show is a good idea ! I think that people do not necessarily know difference between different kind of studies (randomized, retrospective, case controlled ) and also where were they done (one location, multiple, single country or multiple ) etc. etc.
There is no single randomized study that was even done to compare patients who waited and did not - to the contrary , every single world renowned organization who DID randomized studies confirmed - do salvage if all possible BEFORE 0.25 after RP for the best possible outcome.
Members here are starting to mix salvage RT post RP with salvage RT after initial salvage failed - those are completely different categories.
Also, age of patient and comorbidities can make a major difference in proposed recommendations for further treatment.
There are randomized studies for salvage RT post RP that went into 0.05 increases and compared results and that is how they not only came to 0.2 but to 0.25 as a cut-off for the best results.
My sincere advice to all is to read, read and read - find studies and "study". Answer is very obvious regardless what business oriented PC influences on the web say ;).
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@jeffmarc I went 6 years after my prostectomy undetectible, then 1st BCR and salvage radiation and target radiation after PSMA PET/CT showed small pelvic leasion moderate uptake of Gal8 tracer.
This time 22 months on ADT and Bilcal, could not tolerate Zytiga, liver enzymes issue so used bical. That is where I am now and I do trust my physician team.