PSA "undetectible" for amost a year

@johnfinch
Actually, according to the American Society of clinical oncology, you should’ve had Salvage radiation when your PSA hit .2. Waiting as long as you are, could make it worse. Here’s their specific recommendation for those that have had a prostatectomy.

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/

@jeffmarc It kind of feels like you're rushing to respond to things and not actually reading what people write. You wrote this alarmist reply to @johnfinch but his PSA is way below 0.2 -- he says it's 0.041 now, which is 5x lower than that threshold.

Also, that link you shared in your reply does not say all of those things you say it does. Do you have a correct link to a source for this claim:
"≤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%).
"? I don't disagree with the sentiment but I cannot find that quote or those exact numbers in any source.

You share a lot of great info here but you've been missing and misunderstanding a fair bit of what people are writing lately, hope everything is ok on your end.

An interesting article I received that may be interesting? I get a lot of these, if I shouldn't be sharing them let me know and I will stop. I have access to these through a PA.

Do High-Risk Features of Prostate Cancer Boost Hormone Therapy Benefit?
https://www.medscape.com/viewarticle/do-high-risk-features-prostate-cancer-boost-hormone-therapy-2026a1000rop
Here is another interesting one.
How Low Does PSA Need to Go in Metastatic Prostate Cancer?
https://www.medscape.com/viewarticle/how-low-does-psa-need-go-metastatic-prostate-cancer-2026a1000rpa

I think you hit nail on head for those coming on MCC to get the experiences of others.

"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."

It is important to know you are an individual and your guidance should come from your personal research, and consultations from your medical doctors.

Individuals on MCC should be giving their personal experiences with PC but not tell you what to do, or not to do, medically based on what they did or the research they did as they are not you, don't have your full medical and mental health history so should be their personal journey with PC.

Excellent results!

True, with a PSA of <0.02 ng/mL (one year after surgery), there’s no need for adjuvant radiation.

Your current strategy makes sense.

@johnfinch If your PSA numbers are accurate, you are not at the borderline yet; you have to reach 0.2 to be a candidate for SRT - NOT .041
Phil

@diverjer

Very helpful. Please continue sharing articles like these so we can stay informed about the latest studies and analyses on prostate cancer treatments

I have a background question. If a "normal" PSA for men over 60 can be in the 3.0ng/mL range, for men who have been diagnosed and treated for prostate cancer why are the levels of concern 1.0ng/mL or lower, to the point of "detectable"? I put this to Copilot that pointed out that the prostate is usually much smaller after treatment, which is reasonable, but is that it? Thanks.

@notpetecrowarmstrong
You are correct. I misread .041 as .41.

At least he has the recommendations for when he should start worrying about this PSA rising.

@carbcounter

The key is that the PSA ranges are being used in two completely different settings. In a man with an intact prostate, PSA comes from normal prostate tissue as well as cancerous tissue, so a PSA around 3 ng/mL may be within range adjusted for age.
After radical prostatectomy, however, the prostate has been removed, so there should be little or no PSA-producing tissue left. That's why PSA is expected to become undetectable. A subsequent detectable and especially rising PSA can therefore be an early warning that prostate cancer cells may have returned. That's also why post-treatment PSA thresholds are much lower than the "normal" PSA ranges used for men who still have a prostate.