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Detectable PSA 9 years post prostatectomy

Prostate Cancer | Last Active: Sep 27, 2023 | Replies (19)

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@swdg

You might find this interesting: https://www.prostatecancer.news/2016/08/low-detectable-psa-after-prostatectomy.html

I am almost 7 years post surgery. My PSA was undetectable for about 18 months after surgery. Then my PSA started to rise and also would decrease sometimes. Highest value so far was .11, but the next 2 values after that were .09 then .07. I have had no additional treatment, but I am monitoring every 6 months. Should my PSA rise enough, I think I would wait until .5 (?) and then hopefully get one of the newer scans to see if it can be located.

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Replies to "You might find this interesting: https://www.prostatecancer.news/2016/08/low-detectable-psa-after-prostatectomy.html I am almost 7 years post surgery. My PSA was..."

I wouldn't wait for your cancer to return to the point it shows up in a PSMA scan. You're an interesting case in point that even going over 0.1 doesn't necessarily mean you need salvage treatment. The most common criteria I've read is that two successive rising readings above 0.03 could be a decision point if you want to do salvage. Bouncing around without two increases in a row at least 3 months apart would not be a reliable result to go through with salvage. It also boils down to how conservative the Urologist is with salvage treatment. Some may recommend having it done once you have two successive results rising over 0.03, others like you elude to may recommend doing nothing until you have more than 2 rising results and get to 0.5 but by today's standards, that may be a bit late.
https://www.frontiersin.org/articles/10.3389/fonc.2021.742093/full
Noteworthy, very early SRT (PSA 0.01 to 0.2 ng/ml) was associated with a twofold decrease in biochemical failure, use of salvage ADT, and distant metastases compared to early SRT (PSA between 0.2 to 0.5 ng/ml) (87). Similarly, Fossati et al. also concluded that SRT should be given at the earliest sign of PSA rise, and even more so in case of adverse pathological findings

If you do get SRT, make sure it is the latest "MRI guided" radiotherapy.