PSA 0.06 at one year post RARP

@melvinw Back in December Quest, for some reason, sent both, normal and uPSA test results. The uPSA was <0.02 the normsl one said 0.04 (not <0.04). I don’t know why they report the normal one down to such a low level when assay noise can be larger than the psa value.

@topf Baffling. Life was simpler when ther lower limit of detection was 0.1. I do agree with the bulk of the docs I’ve worked with—single data points don’t tell you much, it’s all about trends in the data no matter where you are with respect to the decimal point.

@melvinw Agreed. I guess the advantage of the uPSA is that you can spot a trend and calculate doubling times before it hits 0.1.

Yes, that is the main advantage that I can see, and this is especially so for high risk patients.

Regardless of whatever the lower limit of detection is for any PSA test, once you’ve been treated for prostate cancer, and your PSA becomes or remains detectable, or bumps up from its nadir, it is pretty normal to feel some level of anxiety. My next PSA test is coming up on August 21 and I can feel that low-level anxiety creeping into my consciousness. Rather than fight it, or deny it, I am forevermore working towards just living with that anxiety as it crops up (it’s never extreme, nor debilitating, just annoying).

Well..,

Step back and ask your medical team...

What would the clinical data be that may necessitate a decision on our part to consider initiating treatment!?

Answering that may give you a better way of managing your lab results. You can look at a large picture vice reacting to each result.

For my medical team and I, based on my clinical history's four important clinical factors:

GS8
GG4
PSDT <4 months
PSAV >4 months.

Three or more PSA tests spaced 1-3 months apart that show an increase

and, or...
PSA between .2-.5

Why those?

Well, we don't want to react to a single result. My results from July showed an "increase" from .03 in January to .04.

What did we do? We agreed to test in a month (coming up on 13 August).

If that shows an increase, decide whether to test in a month, two or three...likely three.

The decision criteria does several things.

Prevents reacting to single results.

Gives us measurable criteria for discussing whether or not treatment should be considered.

The .2-.5 is to give us a statistically reasonable chance of a PSMA PET showing where the activity is given my PSADT and PSAV.

Notice at no point have I yet talked about deciding what treatment. We don't do that until we have all the clinical data necessary.

My PSA has gone up and down before though I do my best to control the variables, same lab, same time, same pre-draw routine...

The USPSA begs the question, "just because we can, should we!?"

There is some debate that reacting and treating at USPSA levels may not change outcomes, whether that is OS, PFS, RPFS...

Others, me, like to hit it early and hard.

I believe if Mayo were treating you your PSA would reported at <.1 and you and your medical team would be talking about vacations and when to schedule the next lab..

Over time I have seen people on this and other forums wait until their PSA hit 2-10 before diving into treatment. Their reasoning back to my comment about PSMA PET treatment lead time bias...

What to do, that is a discussion between you and your medical team and your tolerance to "wait" while your PSA rises to initiate treatment discussions and treatment.

It would be nice if there was a black and white answer, if this, then that.

Alas, there is not. This is a heterogenous disease and a heterogenous population. Add the variables of medical teams, well, you do have choices. By and large those will be good choices, they can also be "could do better...!

My "do better" was SRT only to the prostate bed and not add short term systemic therapy and include the whole pelvic lymph nodes in the radiation treatment plan.

Our choices depend in part on our clinical data and our personal preferences for longevity, quality of life, side effect profiles of treatment, how we mitigate those side effects..

So, long answer...

Short answer, talk with your medical team about those decision criteria that would cause you to discuss treatment, then sit back, follow the plan you and your medical team have decided on, live your life.

Kevin

Memorial Sloan kettering, where I am in treatment, considers 0.05 as a non delectable PSA. 0.06 doesn't seem bad. 14 months after my surgery the PSA came 0.09, three months later it came 0.14.
At that time, recurrence was assumed and I was given 40 radiation sessions. In addition, I began a Lupron therapy that lasted 6 years until I asked the suspension of it.

I had RP 5 years ago and my lab always reported my psa as <.1. 2 months ago I had my annual psa at the same lab and it came back as .1. That concerned me as apparently the AUA considers .1 detectable. So contacted my doctor and requested an USPSA. That came back as .128. 1 months ago later my reading was virtually the same. So starting Early Salvage Therapy in 20?sessions with no ADT. Had a Decipher test and it came back as .56, intermediate aggressive and an ArteraAI test that came back with a low score suggesting that ADT is probably not all that beneficial at this time. Research shows that Early Salvage Radiation before the PSA goes over .2 is statistically better than waiting for possibly a total cure!?? You never know but I’m playing the odds!!! Time will tell.

@jamie1957 Have tou made an appointment with a radiologist at a center of excellence to get an opinion? An oncologist would even be better. Urologists are pretty much out of the game once the prostate has been cut out.

@topf
Yes. I’m going to a COE and am now dealing with a Radiation Oncologist.

Yes, it can be a variation. My PSA post prostatectomy has gone up and down, going from undetectable to detectable to undetectable over the last 2.5 years. I've had PSA go from .16 down to undetectable in 3 weeks. Just make sure you use the same lab each time you get it checked.
Your rise is very small, and you have a few years since your operation. You are well below the .2. check it again in a few months and see what happens.