Detectable PSA 9 years post prostatectomy

Posted by snoopers @snoopers, Jun 24 8:44am

I am 9 years post prostatectomy. Until 3 months ago, my annual PSA was always undetectable. Now it is 0.1 on 3 tests over 3 months. My surgeon wants me to have another PSA test in 2 months. If it is still 0.1 (or higher), should I be concerned? What does this signal? What treatment if any?

So, good news, nine years of undetectable PSA after surgery may bode well for you. The generally accepted definition of a BCR is two PSA tests that are detectable, for a standard PSA tests that only measures to one decimal, that would be .2, then another test that comes in at .3. There is a lot of debate in the medical community about what constitutes BCR when using an ultrasensitive PSA test that measures to two decimal places.

Does your PSA test say <.1, before my urologist switched me to the USPSA, my PSA tests would read <.1 which didn't mean it was "undetectable" but that the sensitivity of the test would not measure below that.

When my urologist switched me to USPSA, I have readings like .07, 09, .126…

You say three tests over three months and it remains at .1. So, that would indicate no BCR at this point. Another useful clinical data point would be PSA doubling and velocity times, that would require your PSA to rise over multiple tests, something you are not experiencing.

So, you may want to consider actively monitoring your PSA, monthly may be "too much." You may want to consider every three months. Have decision points, are you going to use the standard PS tests or USPSA, frequency, if you do experience a continuous rise (determine what "contiguous" is, two tests, three tests, four…that would give you PSADT and PSAV. Decide at what point you would image, the recently approved PSMA imaging can detect below .5 but start to have high detection sensitivity at .5.

A reason for multiple tests is sometimes PSA will go down after rising, mine has done that twice, both times we did not hit the panic button as my medical team and I want solid clinical data before considering treatment.

Informed by clinical data, you can then make a decision about treatment, if and with what.

Here's a link to a short video on one of the newly approved imaging capabilities by the FDA – https://www.urotoday.com/transformative-evidence/clinical-application-and-utility-of-pylarify/videos/mediaitem/2129-the-diagnostic-performance-of-psma-pet-ct-with-18f-dcfpyl-in-prostate-cancer-patients-osprey-christopher-wallis-zachary-klaassen.html

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@kujhawk1978

So, good news, nine years of undetectable PSA after surgery may bode well for you. The generally accepted definition of a BCR is two PSA tests that are detectable, for a standard PSA tests that only measures to one decimal, that would be .2, then another test that comes in at .3. There is a lot of debate in the medical community about what constitutes BCR when using an ultrasensitive PSA test that measures to two decimal places.

Does your PSA test say <.1, before my urologist switched me to the USPSA, my PSA tests would read <.1 which didn't mean it was "undetectable" but that the sensitivity of the test would not measure below that.

When my urologist switched me to USPSA, I have readings like .07, 09, .126…

You say three tests over three months and it remains at .1. So, that would indicate no BCR at this point. Another useful clinical data point would be PSA doubling and velocity times, that would require your PSA to rise over multiple tests, something you are not experiencing.

So, you may want to consider actively monitoring your PSA, monthly may be "too much." You may want to consider every three months. Have decision points, are you going to use the standard PS tests or USPSA, frequency, if you do experience a continuous rise (determine what "contiguous" is, two tests, three tests, four…that would give you PSADT and PSAV. Decide at what point you would image, the recently approved PSMA imaging can detect below .5 but start to have high detection sensitivity at .5.

A reason for multiple tests is sometimes PSA will go down after rising, mine has done that twice, both times we did not hit the panic button as my medical team and I want solid clinical data before considering treatment.

Informed by clinical data, you can then make a decision about treatment, if and with what.

Here's a link to a short video on one of the newly approved imaging capabilities by the FDA – https://www.urotoday.com/transformative-evidence/clinical-application-and-utility-of-pylarify/videos/mediaitem/2129-the-diagnostic-performance-of-psma-pet-ct-with-18f-dcfpyl-in-prostate-cancer-patients-osprey-christopher-wallis-zachary-klaassen.html

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Very good reply. I am here at Mayo now receiving another round of salvage radiation for my 4th.reoccurrence since surgery in 2015. My PSA’s have all been in single digits before restarting treatments. 1.8 this time. When I first become detectable again after being off treatment they wanna see that definitive rise before restarting treatments and even the choline and PSMA scans have a hard time finding the cancer if your PSA is below 1.0. I was told “we do not want to over treat you”.

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Im 9.5 yrs since my prostecomy. My current PCP was unaware I had a prostecomy. The PSA readings were always in the 1.x range. When it rose I told my PCP that I had the prostectomy in 2012. The 2 different body scans on me showed only a small tumor. It was beneign. I’m told radiation is needed as I am at high risk to deveope cancer somewhere. At 74 Im not sure I should do the radiation since there isnt a location cause found. The PSA is at 4.1 up from 3.4 in February. Im just looking for info on side affects and cancer risks radiation may cause

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So, if your PSMA is 4,1 then anyone of the FDA approved imaging techniques should be able to locate the site(s) of the recurrence – C11 Choline, Aximun, PSMA…

Armed by that clinical data and other data such as PSADT, PSAV, your overall health, life expectancy…you may then be able to make an informed decision about treatment. If so, you'll have "choices." Those would range from monotherapy which could be radiation or combination therapy which might mean radiation combined with short term ADT.

A choice could also be to do nothing but continue to monitor. Helpful to that decision would be your PSA doubling and velocity times which needs three or more PSA results over time, usually 2-3 months apart. If that is less than six months, may lead to a decision to treat now, if 6-12, maybe, greater than 12, probably not given your age.

As to the side affects of radiation, I have 39 IMRT, 70.2 Gya to the prostate bed and 25 IMRT, 45 Gya to the pelvic lymph nodes. In tribute to the advances in technology, the skill of the radiation team, no side affects for me.

Kevin

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