PSA "undetectible" for amost a year

Glad to hear the PSA results. Especially good news given your pathology. Best thing you can do now is stay on top of the PSA testing.

I had a RARP in 2015. Gleason 3+4, Stage pT2c with one positive margin. Prolaris score gave a 53% chance of BCR in ten years. I was offered adjuvant radiation but opted out becasue my PSA was undetectable (<0.1) and stayed that way for ten years.

In 2023 my uriologist dected a small nodule in my prostate fossa but PSA was still undetectable.

In June 2025, my PSA rose to 0.11. PET scan and MRI confirmed that the nodule was a local recurrence. No evidence of distant metastasis. Caught the recurrence about as early as possible. Did 38 sessions of IMRT in fall of 2025 (no ADT) to treat the recurrence. PSA is still hanging around 0.09, but it can take a while to bottom out, especially if the cancer is indolent. But as long as it is not trending upward, I am fine with any value below 0.1. So far, no major, or even minor, lingering side effects from the radiation.

So, yeah, I made a similar decision to save radiation for an actual recurrence. No regrets on that decision, but keeping up with the PSA testing was a critical component of that strategy.

Hope all continues to go well.

Thanks for sharing excellent news!! 🙏🏽 Celebrate!

@melvinw

Melvin, how did doc detect nodule? DRE?

Yes, a DRE, which he did routinely.

Do you continue to be careful and get at least testing every three months for a couple of more years? While you were a 3+4, which is low risk the advanced issues that came along with it mean that your prostate cancer could come back.

I was a 3+4, but after surgery 4+3. Nothing else aggressive found at the time but 3 1/2 years later it came back and I had to have salvage radiation.

Have you had a decipher or ArteraAI test? That can make a big difference in how comfortable you feel about your future with prostate cancer. Those houses can tell whether or not you are likely to have reoccurrence in the next five or 10 years. You could ask your doctor about getting one.

@jeffmarc The poster says in his second paragraph that he has a high Decipher score.

@melvinw

I agree 100% that you made the right decision by not preemptively starting radiation treatment while your PSA was undetectable. You avoided unnecessary treatment and its potential side effects for ten years—that is huge in my mind.

In addition, I’m pretty sure that by waiting, you have benefited from the availability of more varieties of advanced and targeted radiation treatments than were available 10 years ago, as well as more options for hormone treatments that may be gentler on healthy tissues.

Thanks for sharing your experience, and I wish you all the best in the future.

@soli Yes to all that. I had a good ten years, hardly ever thinking about the prostate cancer, but aware of the post-surgery pathology. When deciding about treatment for the relapse, I had the option of doing ADT. It was a gray area decision, and a lot of factors went into my final decision to forgo ADT and just go with radiation. One of those factors was that I could save the ADT for when and if I required it (and when the benefit to risk ratio was better). And also that in 2, 3, 5 years and beyond, there would be new and improved therapies. Someone else, just as reasonably, might have gone for the “hit it with everything” option, but that was not and still isn’t my approach. Treatment is a mix of medicine, science, statistics and personal values and priorities.

I'm 70, a year out from surgery. I'm still experiencing incontinence but it's decreased from a post surgical peak of 5 pads a day to 3 pads a day. I do the kegels daily. My PSA numbers have crept up from .028 a year ago to .041 now. I'm at the borderline zone for recurrence. The numbers are not disagnostic and not alarming but I understand they are worth monitoring. I've just moved from CA where I was being treated to AZ. I need to find a new urologist. My urologist in CA is keeping track of my PSA results. No talk of radiation yet.

Is anyone else experiencing similar numbers? What's been the urologist's response?

@melvinw
I agree. To be sure, some treatment decisions are clear-cut, but many are much more nuanced. Like you suggested, we have to weigh multiple factors, including the risk-benefit ratio (potential for cure or improved outcomes versus side effects), age, comorbidities, quality-of-life priorities, and personal values before deciding whether to accept treatments such as ADT.

Guidelines and our understanding of ADT have also evolved considerably in recent years, particularly regarding the recommended duration and which patients are most likely to benefit. What makes sense for one person may not necessarily be the right choice for another. Ultimately, treatment decisions are highly individualized and should be made based on both the best available evidence and what matters most to the individual.