Typical Plan When Post RP PSA goes from < 0.02 to >= 0.02?

To the best of my knowledge there is no harm in having another pull of blood and another test to confirm whether the < 0.02 or 0.02 reading occurs again. I'm not the expert on why PSA would fluctuate after the prostate is removed, but I'm sure there are reasons, as we learn more about this all the time.

There is no harm in increasing the frequency of your testing, but I would encourage in the interim time period of testing to self-educate yourself on biochemical recurrence and the various treatment methods that exist (salvage radiation therapy, androgen deprivation therapy, etc.). No one "wants" to join the club of fighting this cancer after taking the radical step of having surgery, but early-detection equates to most-options, so time is on your side if you are well-equipped with information.

The path to approval of treatments varies from what I have seen. I had to do a sequence of bone scan to MRI to CT scan and then I was approved for a PSMA PET scan, fortunately I did that sequence in 5 weeks, but my gut told me to start with the PSMA PET, but the insurance company wanted us to walk our way there. I suspect a similar protocol might exist for salvage radiation.

Keep the faith and enjoy each day, life is fragile enough without having to deal with cancer.

I've read there can be multiple causes for ultrasensitive PSA fluctuations especially for those getting results to 3 decimals! But it seems accuracy better than 0.005 is questionable. From what I just read uPSAs are considered reliable to 0.01. So could mean a 0.015 could be anywhere in between 0.01 to 0.02. It's crazy to think the tests used to only go one decimal and still due for screen purposes. Boy, opting for 3 digit tests seems like a recipe for some serious anxiety. Which I can then see why many places consider "undetectable" as < 0.02. Giving numbers lower than that is splitting hairs in my opinion.

The problem is now I have to live in doubt until my next test. I think I'd prefer to go in a day later for another draw just to rule out lab error which is also a possible factor. That would give me chance of more peace of mind until the next test 3 months later (although someone told me when they hit 0.02 their doctor recommended going in in 2 months rather than 3).

My tests are free being on Platinum insurance plan.

I've read there can be multiple causes for ultrasensitive PSA fluctuations especially for those getting results to 3 decimals! But it seems accuracy better than 0.005 is questionable. From what I just read uPSAs are considered reliable to 0.01. So could mean a 0.015 could be anywhere in between 0.01 to 0.02. It's crazy to think the tests used to only go one decimal and still due for screen purposes. Boy, opting for 3 digit tests seems like a recipe for some serious anxiety. Which I can then see why many places consider "undetectable" as < 0.02. Giving numbers lower than that is splitting hairs in my opinion.

The problem is now I have to live in doubt until my next test. I think I'd prefer to go in a day later for another draw just to rule out lab error which is also a possible factor. That would give me chance of more peace of mind until the next test 3 months later (although someone told me when they hit 0.02 their doctor recommended going in in 2 months rather than 3).

My tests are free being on Platinum insurance plan.

Well, here is my 2 cents worth of input:

PSA/uPSA testing remains confusing to me in a couple of ways.

What I have seen in various sources:

After RP, undetectable has been identified as < .1

After radiation as primary tx, < .2 as a "goal". However PSA reading should go down over time until each man reaches a nadir, and then follow from there.

Focusing on RP only at 72 w/ G 9 and EPE; my initial PSA postop was .19 (confirmed. 18), resulting in immediate referral to Rad Onc.

Salvage radiation plus 4 mos short term ADT.

Blessedly 1st post salvage tx uPSA < .02 undetectable at Quest Labs, the lower limit of its testing accuracy.

Note: Johns Hopkins uPSA testing floor < .03

The difference, as well as lower testing floors, are a mystery to me.

And, a rad tx friend with a different Rad Onc was tested post salvage tx at JH using the std PSA and was reported as < .1 undetectable. Do not know why the different test used.

Generally: Salvage radiation tx post RP initiated at .2 - .4/.5 is the "sweet spot"

See SPPORT trial and PCI video on rising PSA following tx Jan 2023.

However some Rad Oncs initiate tx earlier.

Comment: salvage radiation tx w/ or w/o ADT should be covered by insurance under any scenario when Dr deems it medically necessary.

"Step therapy", such as a bone scan before a PSMA PET scan or denial of treatments still deemed "experimental " are insurance company issues/requirements.

While I am ruminating, Orgovyx is a prescription drug (my Part D Medicare drug plan covered it at a 25% coinsurance; reached catastrophic coverage stage after 4 scrips; the math eluded me).

Eligard/Lupron should be covered more comprehensively under Medicare Part B as injectable.

After 4 mos of Orgovyx, my side effects 95% gone; Testosterone at 1st post tx testing (about 5 mos after completion) had recovered to 274 (439 prior to tx).

And we are informed that PSMA PET Scan only 20 - 30 % reliable at PSA less than .2

I had PSMA PET Scan after RP and prior to Salvage tx which did not identify PCa, and in that situation, the belief is that cancer cells remain in the prostate bed and possibly the prostate lymph nodes (plns).

So radiation to the whole pelvic floor (WPRT) as well as plns prescribed and performed together w/ short course ADT.

So following initial tx decision between RP or Radiation, it appears that the next steps are more varied and Dr dependent.

All somewhat disconcerting.

End where I began: I do not understand the why's and wherefores of the different PSA tests and testing limitations.

May the New Year bring better health and happiness to all. And God bless us, everyone.

Well, here is my 2 cents worth of input:

PSA/uPSA testing remains confusing to me in a couple of ways.

What I have seen in various sources:

After RP, undetectable has been identified as < .1

After radiation as primary tx, < .2 as a "goal". However PSA reading should go down over time until each man reaches a nadir, and then follow from there.

Focusing on RP only at 72 w/ G 9 and EPE; my initial PSA postop was .19 (confirmed. 18), resulting in immediate referral to Rad Onc.

Salvage radiation plus 4 mos short term ADT.

Blessedly 1st post salvage tx uPSA < .02 undetectable at Quest Labs, the lower limit of its testing accuracy.

Note: Johns Hopkins uPSA testing floor < .03

The difference, as well as lower testing floors, are a mystery to me.

And, a rad tx friend with a different Rad Onc was tested post salvage tx at JH using the std PSA and was reported as < .1 undetectable. Do not know why the different test used.

Generally: Salvage radiation tx post RP initiated at .2 - .4/.5 is the "sweet spot"

See SPPORT trial and PCI video on rising PSA following tx Jan 2023.

However some Rad Oncs initiate tx earlier.

Comment: salvage radiation tx w/ or w/o ADT should be covered by insurance under any scenario when Dr deems it medically necessary.

"Step therapy", such as a bone scan before a PSMA PET scan or denial of treatments still deemed "experimental " are insurance company issues/requirements.

While I am ruminating, Orgovyx is a prescription drug (my Part D Medicare drug plan covered it at a 25% coinsurance; reached catastrophic coverage stage after 4 scrips; the math eluded me).

Eligard/Lupron should be covered more comprehensively under Medicare Part B as injectable.

After 4 mos of Orgovyx, my side effects 95% gone; Testosterone at 1st post tx testing (about 5 mos after completion) had recovered to 274 (439 prior to tx).

And we are informed that PSMA PET Scan only 20 - 30 % reliable at PSA less than .2

I had PSMA PET Scan after RP and prior to Salvage tx which did not identify PCa, and in that situation, the belief is that cancer cells remain in the prostate bed and possibly the prostate lymph nodes (plns).

So radiation to the whole pelvic floor (WPRT) as well as plns prescribed and performed together w/ short course ADT.

So following initial tx decision between RP or Radiation, it appears that the next steps are more varied and Dr dependent.

All somewhat disconcerting.

End where I began: I do not understand the why's and wherefores of the different PSA tests and testing limitations.

May the New Year bring better health and happiness to all. And God bless us, everyone.

Was your last test at the same lab? I don't get the Ultra sensitive test done but the hospital reports it as < 0.1 where my Urologist paperwork says 0.1. The missing less than sign may be a typo or simply not recorded. One time my PSA blood test was sent to a different lab with a reference range of 0.03 to 4.0. My result was reported as 0.03. No less than sign. What was the reference range of the test you just took? Try not to worry.