Is PSA 0.032 after radical prostatectomy a normal fluctuation?

Thank you for your insights, all.

Hello - first of all, I do not believe in "Active Surveillance", but of all the gents whose stories I have read on this blog, YOU were the perfect candidate for it. I am rather shocked that a urologist actually suggested and did a radical prostatectomy on you with a Gleason 3+3=6.
That said, something else that is never really talked about here is the fact that: besides the possibility of post-surgical cancerous cells being left behind in your body, despite membranous-capsule contained prostate being documented (non-spreading), there is the possibility that with your 90% healthy, non-cancerous prostate, that the urologist/surgeon, left "healthy" prostate tissue behind in your body...perhaps with NO cancerous tissue left whatsoever (especially without surgical margins!).
That PSA may be slowly rising because of "healthy" prostate tissue that was left in your body. Unfortunately, it will take a couple of years ("post-op Active Surveillance"), to predict that there are enough prostate cells that have grown, to have another PET scan to see if there is any radioactive isotope uptake by what would be cancer cells. Once your PSA gets to 0.5 - 0.8 or greater, then your doctor can decide to do a PET Scan again. But...even a "negative" PET Scan could not completely rule out that you are cancer free. It could be that there just were still not enough cancer cells to take up enough radioactive isotope to be detected, despite an increasing PSA. It could take five years. This may be a real "nail-biter" for you for the next 5-10 years: "Will I" have enough prostate cells that have regrown, present in sufficient quantity to show positive or negative radioactive isotope uptake, and...if the PET Scan is negative, was it done "too soon" before there were enough cancerous cells to have taken-up enough isotope to be detected, or is the negative result because the rising PSA is due to normal healthy prostate cells that are growing?
Such a nerve-racking thing to go through. I wish you had gotten a second opinion before having surgery. I think you would have been a good candidate for Active Surveillance. Good luck to you.

Hi,
I think that whether it’s .02, .03 or .04 its all good as long as it stays consistent over several reading. Some testing protocols used different methods and with my medical provider they even changed labs, different testing company, different assay method. Look for consistency in reading, if it changes investigate on why.

Dave 3+3

Hello All:
I used AI to locate articles about PSA scores and survival; Here are few within the past 5-6 years, which contain large numbers of patients. See attachments for full articles.

Research Articles| April 02, 2020
Risk of Prostate Cancer–related Death Following a Low PSA Level in the PLCO Trial Free
Rebecca Landy Corresponding Author; Lauren C. Houghton; Christine D. Berg; Robert L. Grubb, III; Hormuzd A. Katki

Cancer Prev Res (Phila) (2020) 13 (4): 367–376.
https://doi.org/10.1158/1940-6207.CAPR-19-0397
Risk of Prostate Cancer–related Death Following a Low PSA Level in the PLCO Trial Risk of Prostate Cancer–related Death Following Low PSA

Abstract
Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men (N = 33,897) ages 55–74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993–2001). We estimated 5- and 10-year risks of aggressive cancer (Gleason ≥8 and/or stage III/IV) and 15-year risks of prostate cancer–related mortality for men with baseline PSA ≤ 0.5 ng/mL (N = 4,862), ≤1 ng/mL (N = 15,110), and 1.01–2.5 ng/mL (N = 12,422). A total of 217 men died from prostate cancer through 15 years, although no men with PSA ≤ 1 ng/mL died from prostate cancer within 5 years [95% confidence interval (CI), 0.00%–0.03%]. The 5-year incidence of aggressive disease was low (0.08%; 95% CI, 0.03%–0.12%) for men with PSA ≤ 1 ng/mL, and higher for men with baseline PSA 1.01–2.5 ng/mL (0.51%; 95% CI, 0.38%–0.74%). No men aged ≥65 years with PSA ≤ 0.5 ng/mL died from prostate cancer within 15 years (95% CI, 0.00%–0.32%), and their 10-year incidence of aggressive disease was low (0.25%; 95% CI, 0.00%–0.53%). Compared with white men, black men with PSA ≤ 1 ng/mL had higher 10-year rates of aggressive disease (1.6% vs. 0.4%; P < 0.01). Five-year screening intervals may be appropriate for the 45% of men with PSA ≤ 1 ng/mL. Men ages ≥65 years with PSA ≤ 0.5 ng/mL could consider stopping screening. Substantial risk disparities suggest appropriate screening intervals could depend on race/ethnicity.

Swedish Study: 2025
Incidence and prognostic implications of prostate-
specific antigen persistence and relapse after radical
prostatectomy: population-based study
Pietro Scilipoti ,Marcus Westerberg , MD, Hans Garmo, PhD1, Rolf Gedeborg , PhD
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
MD, PhD, David Robinson
Division of Experimental Oncology/Unit of Urology, URI Institution, IRCCS Ospedale San Raffaele, Milan, Italy

Department of Urology, Ryhov Hospital, J€ onk€ oping, Sweden
, MD, PhD3, P€ ar Stattin, MD, PhD1,
�Corresponding author: Marcus Westerberg, PhD, Department of Surgical Sciences, Uppsala University, SE-752 37 Uppsala, Sweden (marcus.westerberg@uu.se).
Abstract
Background: There has been a wide range in incidence of prostate-specific antigen (PSA) persistence and relapse after radical prostatectomy (RP) for prostate cancer (PCa). We aimed to describe incidence and prognostic implications of PSA persistence and relapse.
Methods: Register-based cohort study in Sweden of men diagnosed with PCa between 2007 and 2020 who underwent RP. Risks were estimated using competing risk cumulative incidence curves. Treatment after persistence or relapse and risk of PCa death and other causes were stratified according to persistence, European Association of Urology relapse risk groups, time to relapse, and life expectancy based on age and comorbidities.
Results: Among 10, 700 men, the 10-year risk of PSA persistence or relapse after RP was 34% (95% confidence interval ¼ 32% to 35%).
Within 12 months of persistence/relapse, 75% of men with persistence, high-risk relapse, or early relapse (<2years) received treatment. The 10-year risk of PCa death ranged from 12% for men with persistence to 2% in men with low-risk relapse, whereas death from other causes ranged from 11% to 16%. Risk of PCa death was 8.5% after early relapse (<2years) and 1.4% after late relapse (>5years).
Conclusions: This population-based study estimated that one-third of men would have PSA persistence or relapse within 10 years from RP. There was a wide range in risk of death from PCa according to cancer characteristics and time to relapse. Risk of death from other causes was substantial. These factors, along with life expectancy, should inform treatment decisions for men with persistence or relapse.