PSA "undetectable" for amost a year: Continue to monitor

Posted by soli @soli, Aug 15 9:29am

The fourth consecutive PSA result came back at <0.02 ng/mL, nearly one year after surgery.

Four consecutive undetectable PSAs over nearly a year are certainly reassuring and indicate that there is currently no detectable biochemical recurrence. However, they do not mean it is “all clear.” They also do not erase my longer-term recurrence risk given my adverse pathology and biology: Gleason 3+4, pT3b with seminal-vesicle involvement, extracapsular extension, lymphovascular and perineural invasion, and a high Decipher score.

For now, I plan to continue with my current strategy of regular PSA monitoring and reserving salvage radiation for a confirmed rising PSA rather than automatically pursuing adjuvant radiation. Why subject myself to treatment and its potential side effects before I need it? If there is roughly a 50% chance that I will not experience a recurrence, why undergo treatment now that may ultimately never be necessary?

I’m encouraged by the continued undetectable PSA and, as always, I welcome any and all input from the group.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

diverjer | @diverjer | Aug 19 3:11pm

In reply to @heavyphil "@diverjer DO IT!! Schedule with the pathologist ASAP." + (show)

@heavyphil
I plan on it, I did promise her I would try to get answers from Oncologist and RO first. So I will keep that promise and see them on 24th, than schedule her.

optimistic | @optimistic | Aug 22 9:37am

@soli I am in a similar situation as you-surgery a bit over a year ago, pT3b, Gleason 8, with seminal vesicle involvement, though pelvic lymph nodes all came back clean. PSA has been <0.02 all along, including my latest at a bit over 1 year post-surgery.

I'm not seeing anything that can be done other than follow PSA and hope that you and I are in the 50% where there is no recurrence. Radiation? What would you irradiate? PSMA-PET scan is almost guaranteed not to show anything with PSA <0.02, so there would be no guidance there. ADT? I don't know of any data that doing it at these PSA levels would be any more effective than waiting until PSA rises. One thing to keep in mind is that cancer cells will mutate to escape treatment. Going in before there is a recurrence would only favor any recurrence being androgen-independent.

Best of luck to both of us...

Jeff Marchi | @jeffmarc | Aug 22 10:43am

In reply to @optimistic "@soli I am in a similar situation as you-surgery a bit over a year ago, pT3b,..." + (show)

@optimistic
If the PET scan shows nothing, they radiate the prostate bed and the lymph nodes near it. Most likely place for a reoccurrence.

I had a prostatectomy 16 years ago and 3 1/2 years later it came back and I had salvage radiation. That worked for 2 1/2 years at which point it came back again and I went on ADT. In my case, it keeps coming back because I have BRCA2, a genetic problem. Many people Have long-term remission after salvage radiation.

soli | @soli | Aug 22 10:59am

In reply to @optimistic "@soli I am in a similar situation as you-surgery a bit over a year ago, pT3b,..." + (show)

@optimistic

I can see we’re in the same boat. Hopefully, there will be no recurrence at all—but if one does occur, let it occur just before we die of something else! 😊

On a more serious note, if recurrence does happen, I hope it is delayed long enough that we have much better imaging and treatment options available—treatments that can target the cancer more precisely while causing less collateral damage and toxicity.

jc76 | @jc76 | 5 days ago

In reply to @optimistic "@soli I am in a similar situation as you-surgery a bit over a year ago, pT3b,..." + (show)

@optimistic
I love your I.D. you chose. Something very important in life!!

soli | @soli | 20 hours ago

In reply to @jeffmarc "Do you continue to be careful and get at least testing every three months for a..." + (show)

@jeffmarc

Oops, I missed this. If your question was directed to me, yes, I had both GPS and Decipher tests. My Decipher score was 0.75 and my GPS score was 47, with both indicating aggressive tumor biology and an appreciable risk of metastasis over the next 5–10 years.

When I input my PSA and pathological risk factors into the Memorial Sloan Kettering nomogram, my estimated probability of remaining recurrence-free after surgery is 81% at 2 years, 61% at 5 years, 52% at 7 years, and 43% at 10 years.

Bottom line: it is not all clear, and I need to continue with serial PSA testing. My doctor and I made a joint decision to test every 4 months going forward, rather than every 3 months as we did during the first year after prostatectomy.

Jeff Marchi | @jeffmarc | 19 hours ago

In reply to @soli "@jeffmarc Oops, I missed this. If your question was directed to me, yes, I had both..." + (show)

@soli
Usually, what happens is you get three or four month test for a couple years then you get every six months for a couple/few years then you go to once a year.

It depends on whether your PSA moves.

optimistic | @optimistic | 18 hours ago

In reply to @soli "@jeffmarc Oops, I missed this. If your question was directed to me, yes, I had both..." + (show)

@soli I had similar numbers on the MSK nomogram, if I recall correctly. While I don't doubt the numbers, it's not clear that it changes anything about how I'm living my life.

My docs have had me testing every 6 months and I will continue that for the next couple of years then go to annual. I would have no problem testing more frequently, but if the PSA is undetectable at 6 months then it was undetectable at 3 or 4 months so it doesn't change much. If/when a number comes back above undetectable, then I would want to test more frequently in order to get a doubling time and plan treatment,

jc76 | @jc76 | 7 hours ago

In reply to @optimistic "@soli I had similar numbers on the MSK nomogram, if I recall correctly. While I don't..." + (show)

@optimistic @soli
The decision on the frequency of when you get your PSA tests depends on what your doctors want. Only they know your completed medical and mental health history and your specific journey with P.C.

Only they can decide and recommend to you what is best for you and your specific case of P.C. not statistics or what others did.

I know my PSA only went up one time after radiation but was told completely normal and what was their concern was if it kept going up not just an occasionally bump.

My UHFPTI R/O suggested could move to every 6 months but my PCP at Mayo wanted to stay with every 3 months just to keep vigilant.

I would suggest you follow what your doctors recommend for you. A lot will depend on your specific cancer, and what type of treatments you had. That comes from my medical doctors not a seminar so really focus on your specific journey and what your doctors are recommended to you specifically.

kjacko | @kjacko | 4 hours ago

My situation has been similar. My urologist believes salvage radiation should be used only when my PSA rises. My three year”anniversary” of undetectable PSA is in October. Always hoping and praying for same, and will do the same for you as well. Best wishes.