Detectable PSA 9 years post prostatectomy

In general, I don't think any Oncologist or Urologist is going to recommend any action until you hit > 0.03 and rising (I think many won't go ahead with treatment until 0.05) There are many studies on prognositic accuracy of Ultrasensative PSA results. 0.01 is generally considered a "coin toss" point. Other studies think that .006 is useful but there are too many other variables I think to accurately predict the reliability at that low of a level. In a study the cohort is going to have varying pre and post treatment factors including pre-treatment PSA, genetics, lifestyle factors, etc. My University of Washington, known for their Urology clinic and cancer expertise, uses a test that considers undectable to be < 0.02. Which makes sense as some studies have shown men > 0.01 and < 0.03 that never had recurrence. You don't want to overtreat. Salvage treatment used to be done with two consecutive reading > 0.2! The > 0.03 cutoff now gives roughly 2 years more advance warning compared to the 0.2 cutoff giving the salvage treatment a much higher chance of success.

This is a good article:
https://prostatecancerinfolink.net/2015/09/12/johns-hopkins-ultrasensitive-psa-after-surgery-predicts-biochemical-relapse/
I would guess you would have gotten salvage treatment by now if you hit a 0.1 (not 0.01)

If it's always been undetectable, then you haven't had ultrasensitive PSA [uPSA] tests, which Jazee is referencing. I assume that since you went from undetectable to 0.1, the low end cutoff for the standard PSA test. Without using the uPSA, the urologist is looking for two things--confirmation, and rate of increase, which he/she still doesn't have.

Since you are no longer a candidate for surgery (you are post radical prostatectomy [pRP],) this might be a good time to get a referral to another specialist who focuses on "advanced" or biochemically recurring cancer [BCR]. That way if you do end up needing more treatment you are already connected with someone focused on providing that kind of treatment.

On the other hand, if you're comfortable with your current urologist (even though he hasn't prescribed uPSA tests for 9 years,) you might want to just look around at options during the next two months and wait for the next data point.

I am one year out, seeing my surgeon/urologist with a specialty in prostate cancer, and have had two standard PSAs "undetectable" followed by 3 uPSAs. (The second PSA was supposed to be uPSA, but a mistake was made somewhere.) My scores have been

I just read that article you cite. That is just what I was looking for yesterday!

The related question I have is about variance. With uPSA tests, how much test/retest variance is there? In my case, I now have 3 3 month uPSAs, 0.012, 0.016, 0.012. Is that likely to be random variation or something else? (I'm using LabCorp, I understand there is more than one assay (testing strategy).)

Your article suggests that 0.03 is a meaningful cutoff, in which case I have at least one more, possibly several or many, to find out how the sequence emerges for me.

Since I'm new to this forum, I didn't see the first page of responses before my comments. I see @kujhawk1978 provides an extensive sequence, which is helpful. I notice he uses USPSA for what I've seen abbreviated uPSA and he adds KCUC, which I'm guessing is his testing site in Kansas City. It's encouraging to me to hear from people farther out in the journey.

Interesting discussion. This is my first post. After RP in 2018 my first PSA reading was undetectable

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.

Just finished 39 salvage tx, with Eligard every 90days. Only side effects occasional mild fatigue (I work through it), intermittent hot flashes (some extreme) I understand my wife complaints. 68 years old Gleason 9
Living Life..

I know your post was a couple years ago but I'll throw in my $0.25 worth for those finding this thread.

I was diagnosed 20 months ago and had a robotic prostatectomy 16 months ago. I'd say I spent, conservatively, 200 hrs reading everything I could about the disease and its treatment.

There are too many studies for me to list as I have learned to get on with my life and stop obsessing over whether my cancer is coming back and what I will do about it. But I can give you my personal summary based on a lot of reading of studies released all the way into 2022.

There are dozens of studies regarding short and long-term outcomes post-prostatectomy related to Ultra Sensitive PSA tests. Some studies use a 0.01 cutoff, others 0.03, some 0.04, and of course there's the more traditional non-ultrasensitice cutoff of 0.2. My opinion coincides with what most Centers of Excellence have chosen as the best cutoff point which is 0.02. The reason being is results below that are too unreliable for predicting with a high degree of certainty whether you are having biochemical recurrence or not without risking overtreatment.

So at two different Center of Excellence (at University and a regional medical center) my PSA result comes back "< 0.02" and I don't know what the actual number is. Because if it's less than 0.02 it's not actionable and is just going to cause a cancer survivor undue stress watching their number climb or bounce around at levels < 0.02 levels.

My understanding is current practice for the top Urologists who keep abreast of all the studies and treatments is that they will not recommend considering salvage treatment until you have two consecutive readings that are rising and above 0.03. The effectiveness of salvage therapy goes down the higher your PSA rises. The average PSA these days in at least one study for salvage therapy was 0.08. Far lower than the 0.2-0.5 range it occurred at in many years past. It's because the outcome is better the sooner you do it but you only want to do it if your PSA has risen to a level that has been statistically proven to reliably predict BCR. Probably a lot of patients hit 0.04 to 0.08 when they decide to get salvage therapy and by the time they get into the treatment clinic their PSA is at 0.06 - 0.12 or so hence the 0.08 average.

So in a nutshell, in my opinion, if your PSA is < 0.02 you have nothing to worry about or discuss with your doctor. You can still ask to put your mind at ease. I don't even have a Urologist anymore since I moved to another state so only my primary care physician is seeing my PSA results every 3 months and she has no clue about what to do when, as prostate cancer is not her speciality of course. I'm not going to get on a plane or in a car or schedule a teleconference with a Urologist at UCLA or UCSF until I see my PSA go above 0.03. Hopefully that will never happen. Anything lower than that, even at 0.025, and all the Urologist is going to do is say let's wait and see what your next test result is 3 months from now. I can do that on my own!

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.

Sorry I didn't realize I replied already in this read so excuse my redundancy. That's what happens in a case of information overload.