Pathology report is in post RALP; waiting 90 days for PSA test normal?

I would go for first one in six weeks. I would not wait until 3 months. My Surgeon as everyone knows is opposed to routine ultra sensitive tests but still pulled his first PSA at six weeks. It does appear that their are several possibly disconcerting listings in your pathology, the cribriform but I think more important it appears possible positive margin how i read it as invasive carcinoma present along margin along with the perineural , lymphatic and or vascular invasion all present. I am not one to push ultra sensitive as every one knows but believe I would ask for it. I do think you want to stay on top of it. I hope your recovery has been going fine from the actual surgery.

Yes, it is common to wait 3 months for the first uPSA test, even with adverse pathology like yours. This is because it's not unusual for PSA levels to continue to drop over those first 3 months before reaching nadir during the 3-to-6 month period.

That said, @wheel1 makes valid points and I've seen at least one study claiming that the 6-week PSA level has real prognostic value in terms of assigning a probability to eventual recurrence, so you may wish to have that data point in hand.

As far as treatment goes, however, adjuvant radiotherapy is rarely given these days, ever since the RADICALS study rigorously established that there was no long-term survival benefit to adjuvant treatment over early salvage. Waiting 3 months is not only not going to make things worse for you, it will be giving your body essential time to heal from surgery. You want to achieve some baseline recovery and ideally regain full continence before starting radiotherapy.

The fact that all your lymph nodes tested negative and you were staged as T2 is very good news, even with the cribriform and positive margin.

Best of luck.

@notpetecrowarmstrong
Exactly getting that data point.

My first PSA after surgery was at eight weeks. It was undetectable.

I think you are getting a little jumpy about this. The doctor isn’t that far off from doing the Standard of care just a little late on the first PSA.

If you’re itching to get radiation sooner, there are some information from one of the real experts in the prostate cancer field. You are a pT2, Not all that aggressive.

Adjuvant radiation
Dr. Efstathiou concluded as follows:b
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

Please see the thread "Is PSA 0.032 after radical prostatectomy a normal fluctuation?After ra" in today's list of topics.
You have some aggressive features but not many, and your staging is good. I would get a Decipher test or something similar, as I think it is becoming more and more important in determining just how aggressive your cancer is. If it comes back high, then I would err on the side of ultra-sensitive tests more often.

RP Aug 2022. 1st PSA postop 90 days Nov 2022 at JH.
My PSA was persistent at .19
Initiated SRT Feb - June 2023
Some literature suggests 6 mo healing time post RP and prior to SRT.
Best wishes for an undetectable PSA post-op.

Your original PSA is supposed to go down rapidly. It should be half in value every 3 days. My husband had some high risk features and he had test at 6 weeks and than again in 6 weeks to confirm undetectable, and of course it was always ultra sensitive test.

Anybody with high gleason, cribriform or IDC and especially lymph-node involvement (as you said you have) should do ultra sensitive tests and IMHO in a first year every month. You have positive margin also - please make sure to be very active in your PC care since you need to be on top of situation regardless what your doctor says. I hope that you are having care in cancer center of excellence, even though I have to baby-sit my husband's doctors too in a mayor center.

Good that you are here and that your are making sure that all is done correctly and to your benefit.

Wishing you all the best 🍀 and remember, if your first uPSA is undetectable it is a good sign, BUT until the whole year passes without any rise in value, you should be very vigilant .