← Return to Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?

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Profile picture for Jeff Marchi @jeffmarc

@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/
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Replies to "@beachflyer If you do not have an ultrasound sensitive test, you get one decimal point. If..."

@jeffmarc
Hi Jeff
Thank you for the link and the PSA test references. The salvage radiation article was interesting, and I liked the reference to all-cause mortality as that is a truer picture of outcome. From a curative perspective I agree that early salvage RT results in a better outcome, but supposedly it only has about a 33% chance of hitting the tumors (based on Dr Quan) and one must accept the side effects with less than 50/50 odds. …ughhh…another conundrum on the PC train ride! Meanwhile my surgical team takes a “go slow” approach to BCR treatment to reduce exposure to unnecessary procedures and side effects. I suppose that is why these forums are so important along with second opinions from a Center of Excellence!
It is interesting that the American Society of clinical Oncology takes an aggressive stance on BCR (that I can understand) and yet they are one of the groups recommending no PSA testing for men after age 70 to which I tell all men to ignore such guidance, be your own advocate and get your PSA tested annually.