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Low, But Rising PSA--Wait for Imaging or Act Now?
Prostate Cancer | Last Active: May 11 3:56pm | Replies (72)Comment receiving replies
Thanks to all for the input; it is truly appreciated. And sorry to our vets who took home a nasty surprise while serving our country in VN. I waited to post until I had some new information.
My stats are in the original post but suffice it to say I am 72, had RALP on 9/22/25 and my cancer is aggressive. PSA results post RALP: 12/30/25: < .1; 4/5/26: 0.171; 5/4/26: 0.180. So, like @suftohealth88's husband, I have BCR (he and I have very similar stories; see "uPSA today 0.13 : (((" thread also with posts today).
I saw Dr. Nagur in MSK on 5/6. He very quickly dismissed the Dr. Kwon approach of waiting till 0.2 PSA to get a PMSA PET scan by saying "why would you wait for metastases?" He also said getting the scan now was "standard of care."
He knew I was going to be treated in Johns Hopkins (JH)/Sibley so he seemed reluctant to offer much as to his opinion on proper treatment. In fact at one point I had to say "I came to NY from DC because I want your opinion." He recommended 6 months of ORGOVYX and radiation, with exact details of radiation to be determined by JH. I was expecting much more aggressive treatment and reminded him I have IDC and Cribriform, but he didn't change his recommendation. I was so surprised and happy with that outcome that I didn't press him more on it, as I should have. Honestly, it seemed he didn't want to get into much detail because my treatment was in DC, or he just wanted to wait for the results of the tests he recommended: PSMA PET, Decipher (on tissue from the prostate itself, not the biopsy core, as before) and AlteraAI.
I have an appointment with Dr. Greco (RO) on 5/14 and with Dr. Paller (MO) on 6/16 (thanks for the recommendations for her). I have already asked Dr. Greco to order the PMSA PET but haven't heard back yet. My PSA could be 0.2 by the time it happens, anyway, unfortunately.
@surftohealth88, Happy Mothers Day (please excuse this if you and your husband don't have kids). In any event, I hope you and your husband have a great day.
I am on my way back east from SFO and I will be mountain biking in Moab tomorrow and Tuesday along the way.
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@bikeman1
You hear what Doctor Kwon And Doctor Scholz Say at PCRI conferences. They like to wait for the metastasis to show up rather than treat them with salvage radiation.
Then there’s the facts about what happens if somebody waits when they have an aggressive case of prostate cancer. It’s not a pretty picture. My notes about it are below the link,
Life expectancy for prostate cancer patients that ignore treatment
https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/168250-natural-history-of-untreated-prostate-cancer-a-comprehensive-review-of-long-term-progression-patterns-and-survival-outcomes-beyond-the-abstract.html
Grade Group 1 (Gleason 6) disease showed metastatic progression rates below 5% over 15–20 years and prostate cancer-specific mortality under 5% at two decades. These are the patients for whom active surveillance was designed, and this review provides robust quantitative backing for that approach. Conversely, Grade Groups 4–5 (Gleason 8–10) were uniformly lethal in conservatively managed cohorts: median time to metastasis was 3–5 years for Gleason 8 and just 1–3 years for Gleason 9–10, underscoring the urgency of early intervention for these men.
The intermediate grades deserve particular attention. The distinction between Gleason 3+4 and 4+3—both classified as "Grade Group 2–3" and both often lumped together as "intermediate risk"—carries meaningful clinical weight. Our synthesis found roughly 2–3 fold differences in 15-year progression rates (35% vs. 55%) and hazard ratios for cancer-specific death of 2.1–3.2 between these two patterns. Clinicians and patients should not treat these as equivalent.