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Low, But Rising PSA--Wait for Imaging or Act Now?

Prostate Cancer | Last Active: May 11 3:56pm | Replies (72)

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Profile picture for Jeff Marchi @jeffmarc

@clevelandguy
Between 20 and 40% of the people that have prostatectomy have a reoccurrence. In the majority of those cases, no metastasis is found.

The American Society of clinical oncologist does not agree with you.

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/

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Replies to "@clevelandguy Between 20 and 40% of the people that have prostatectomy have a reoccurrence. In the..."

@jeffmarc
Very simple, you look at what the experts say, talk with your doctor team and then you make a decision. It just makes sense to me to radiate an area that has detectable cancer vs radiating an area that could have cancer. My choice, you might choose differently.