Concerned that I have hit BCR

Your PSA is still very low and remember, it can move around a bit even at very low levels.
That said, it is completely unnerving and anxiety inducing when you see this number start to rise.
As you’ve indicated, the presence of cribriform and IDC does put you at risk for recurrence; so you should probably be placed on a 3 month PSA testing interval to see if there is meaningful change in your PSA, as well as the PSA velocity, which is key.
Usually, no treatment will be instituted until you reach a PSA value of .2 but if it is clear to your oncologist that BCR is occurring you can start treatment sooner. ADT would be necessary as well as salvage radiation.
The salvage treatment should not be feared - IMO, the anxiety of waiting (and projecting) is far worse than anything.
Phil

Congratulations on being undetectable for two years.

In answer to your question, I would recommend asking your oncologist next steps and expect the doctor to reply that you will continue with PSA tests every three months and if your PSA increases above 0.1, you will discuss and decide upon a next treatment to be initiated before 0.2 ng/ml.

You have time to ensure any next treatment needed is consistent with the most recent guidelines and new developments that best meet the needs of your specific condition.

If your PSA rises above 0.1, you can peak your knowledge by researching the PCRI.org videos regarding post RALP BCR and asking more specific questions in this forum.

Otherwise, once you do any actions that you can do today with the PSA information, I hope that you make the most of this day and the next.

As @heavyphil mentioned, monitor your PSA and PSA Velocity (as well as your PSA Doubling Time) more closely,

Though a PSA of 0.2 ng/mL following prostatectomy is the technical definition of BCR, recurrence can occur before that threshold is reached.

So, if it’s suspected that BCR is occurring, first try to find out where it is - work with your medical team to get a PSMA PET scan. (If you can find it, you can fight it!). Then come up with a plan to attack it.

Dr. Kwon (of Mayo Clinic) has some recommendations on how to deal with BCR: https://youtu.be/Q2joD360_pI

I'm not a medical professional nor an expert on laboratory testing, but my layman's understanding of PSA testing machines is that they have to be routinely calibrated and in studies testing their accuracy there's an error range. I totally understand your concern, but my first psa test done 3 months after surgery was .04. I was a bit worried until I spoke with my brothr who, coincidentally, happened to get a psa test around the same time at the same lab. His test had also come back as .04 even though his psa has been undetectable for 2 decades. He just matter of factly told me that mine was just the machine and my psa was probably undetectable. Sure enough, my next psa test they did it on a different type of machine and it was < .1. Since then the lab did my last 2 tests on the same type of machine as the first time and it's been < .04. I think the trend is more reliable compared to one reading with such a slight difference. Just my 2 cents. Best wishes.

PSA does go up and down a little. Wait a couple of future tests and see what is happening. You shouldn’t wait more than three months between blood tests If you think it’s rising. I’ve gotten them every month for eight years.

You do not have to do anything until your PSA reaches .2. You just went up .01 which is pretty insignificant.

I attend advanced prostate cancer weekly meetings with Ancan.org. Frequently people come in with small changes in their PSA that they are just panicked about. And the vast majority of cases, it means nothing and they do not have a consistent rise in PSA. Talk about longevity, Couple of months ago one guy came in and he was a Gleason nine and his cancer came back following a prostatectomy, 30 years later.

In your case with such a low volume of cancer, it’s possible they did get it all.

During the latest PCI conference, the following was discussed. Dr’s Kwon and Moyad agree to this. Seeds for metastasis were already there when surgery was done, waiting to grow.

I am also a 4+3. It took 3 1/2 years before my first reoccurrence after prostatectomy.

It is also possible that your cancer is coming back. The cribriform is a real problem and can require radiation after surgery to really eliminate it, in some cases, like after SBRT.

Research indicates that the presence of cribriform morphology, especially when it's extensive, is a strong predictor of biochemical recurrence after radical prostatectomy.

The presence of cribriform pattern can help doctors identify patients at higher risk of recurrence who may benefit from more intensive post-operative monitoring or treatment strategies.

A lot of this is just things to think about and discuss with your doctor.

Thank you. Yes the anxiety has been horrible - it is tough for me to function knowing I have PSA and potentially cancer growing inside of me again.

Thank you I worry I could be in the state of not really knowing for months or even longer and it’s tough for me to process life with this thought in the background,

I completed my test immediately after a heavy peloton bike ride - showered. - drive to the lab. I am clutching at any straws to think that this was a random bump up in PSA but honestly I am just terrified of this disease becoming my day to day life until I die.

Thank you - I want to hope that salvage could be a chance at curing this again, but I know the odds are even worse.

I know - it took over a year for my PSA to reach .18 once we knew it was trending upward. I wanted treatment sooner but the RO at Sloan said that I had to wait for .2 in order to have a PSMA PET scan. It showed nothing but in the past year it’s been discovered that it is not totally reliable for detecting metastasis.
In the meantime, you could have a PSE test which shows the presence of prostate cancer - like 97% accurate.
At least you’ll know -as will your oncologist - and perhaps you can be more proactive now and not have to sit there and sweat it out…