Connect
← Return to Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?
Discussion
Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?
Prostate Cancer | Last Active: 44 minutes ago | Replies (81)Comment receiving replies
Hi Tom,
I agree with Jeff and other posters that more tests PSA tests are needed to determine if this is an upward trend or anomaly. While going from .01 to .02 between tests is concerning, it is really tough to tell how long it has been creeping up from .01 if your test for example is limited to the 2 digits. If future PSA tests indicate a trend, your Urologist will likely look at PSA velocity (rise/time). I am two years post RALP (Gleason 3+4) and am part of a research study at UC Irvine Medical Center (a COE) that was a part of my RALP surgical procedure that included a urethral sparring technique and other things. As such I meet/speak with the surgeon Dr Ahlering UCI Urology Chair (ret) or his or UCI's surgical team every 6 months. Like most men on this forum, I am always nervous about my PSA (prostate specific ANXIETY) tests every 6 months as my PSA tests ordered by my primary care vary up and down (.04, .05, .03) however my PSA ultrasensitive test w/HAMA ordered by UCI Medical Center as part of my study participation comes back at <.02 thus far.
Just last week when I was on my ZOOM meeting with the UCI team I asked, ..."what happens if my PSA rises?" The answer was... it depends on how fast (PSA velocity), and what my tumor pathology was, along with post surgical outcomes/features. If non aggressive features with doubling times greater than 12 months then they might recommend post RALP AS (active surveillance). If rising fast then they would recommend a secondary treatment after a PET PMSA scan that would hopefully light up lesions that could be individually targeted versus prostate bed radiation where only about 1 out of 3 BCR lesions occur (according to Dr Quan).
Interestingly, this UCI Medical Center has quite a few men under "RALP AS" including one man with a PSA that has risen to 4 over the past 25 years who shows no lesions in PET PMSA scans and has no symptoms. In his case, whatever cells escaped the prostate or were left behind from the RALP are non aggressive.
I will keep my fingers crossed for you that your spike was a test anomaly!
Replies to "Hi Tom, I agree with Jeff and other posters that more tests PSA tests are needed..."
Connect
@beachflyer
If you do not have an ultrasound sensitive test, you get one decimal point. If you get an ultra sensitive test, you get more than one decimal point, .02 is an ultra sensitive test. Could be they just don’t need to add more decimal points with this result.
The American Society of clinical Oncology has a completely different point of view about What you should do if your PSA rises after a prostatectomy. A lot of medical centers field the same way. Once PSA hits .2 After surgery,they recommend salvage radiation, They don’t wait for doubling rate, because early treatment results in long-term progression free survival.
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/
.