PSA "undetectible" for amost a year

@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.

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.

@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
Thanks for responding. At .041 my current PSA number is significantly less than .2. If it gets as high as .2 I hope my urologist recommends radiation.

@carbcounter
The answer to this question Is based on the treatment the person received.

If someone gets a prostatectomy then the PSA should stay undetectable. If It reaches .2 It is considered a case of reoccurrence and should be treated with radiation. There are a few cases where people have reached .2 and it just stayed there.

When it comes to radiation treatment for prostate cancer, the standard is that they don’t treat until the PSA reaches two points above the lowest it ever reached following radiation. If after radiation, it hit .1 then they would not treat until it hits 2.1. It would make sense to do a PSMA PET scan after it hits 1 since it is more likely to show if a Metastasis is causing the rise.

@johnfinch
Sorry that I misread your .041 as .41. It is definitely low at this point. You have a while before it even reaches .2 if it does. At least now you know what the options are for getting treated.

When my PSA hit .2 after a prostatectomy, I was given a Lupon shot and two months later had salvage radiation. That’s sort of the ideal treatment, They didn’t have PSMA PET scans back then. Today you can have a scan and see if something shows up that can be zapped before SRT.