Do I have a prostate cancer recorrence PSA >.1 to 1.5 in 16 months

It looks like your non-ADT nadir was 0.74 so it has just doubled. However, the initial increase to 0.8 is quite high that makes it favorable for recurrence. You still want to use the ADT low for insurance purposes. If you have an increase of 1 to 1.74 more likely than not to be a recurrence. Will get very good PSMA PET imaging at those levels. At the increase levels I do not think another 2 months will harm you. Will your insurance cover a PSMA PET now? Will your doctor order one? If both are not yes that may affect your decision since these scans are not cheap.

You’ve given six PSA readings which means you’re getting a PSA Test twice a month. That sure would be quite unusual.

Normally, if you have radiation, they do not want to do treatment until the PSA hits two points above the minimum which in your case would be 2.01.

If your PSA is really over one right now, you should be getting a PSMA pet test To see if there’s a visible Metastasis somewhere.

Thank you @jim18 , to provide me the above advice. Appreciate it whole heartedly. My radiologist put in an order for a psma/pet MRI. (I need to make sure it is whole body mri, not just pelvis). I am thinking to do it after the next PSA test around July 30th. If the number drops, maybe I don't need the scan....

@jeffmarc

Thank you for your reply.
My PSA is every 3 months. I finished the radiation August 2024, so it has been 20 months.

@laojia A PSMA/PET is a CT scan that goes neck to mid-thigh and is to determine if there are metastases outside the prostate. The prostate should always light up if present (no RP). A Pelvic MRI would be used to determine if there were lesions within the prostate.

My RO said that although a rise of 2 points is the standard for getting a PSMA pet scan, she said that if my PSA went up by 1 point, she would recommend a PSMA pet scan.

@laojia
Your PSA is high enough to get a P SMA pet test. How do you spoke to your doctor about this? They should be keeping track of what’s going on and should already have set up a pet.

An MRI would not be the right test.

I would get the PSMA. But typically the velocity of increase would be greater than you last test.
By that I mean the .88 to 1.23 was a big jump. The next rise was slower. That does look a bit like a bounce curve. It’s a bit late for a bounce, but they happen and can take longer to resolve.
I went from 2.4 to 2.97 to 4.02. Had a negative scan last week.
If mine is a bounce it will be my third.
But my Dr., like yours didn’t want to wait for a scan. (Which I’m grateful for)

Short answer, inquiring minds want to know...

Possibly, yes, likely, maybe. PSA is part of the answer, it points to yes. Other clinical data such as a PSMA PET may provide confirmatory data. Then again, you need to think through what you'll do if the scan comes back negative, a possibility though statistically, small.

My PSMA PET in March 2023 was done at .7, identified a single lymph node.

As others have said, a PSMA PET may answer the question.

I'm going to throw the BS penalty flag on your RO..."My RO said that although a rise of 2 points is the standard for getting a PSMA pet scan..."

Your medical team can order a PSMA PET at much lower PSA. There is always the question of one's insurance company or in some countries based on national health care policies.

To close out, as others have said, get the PSMA PET now. If it comes back hit, you have your answer and can discuss treatment choices with your medical team.

If it comes back negative, well, you are in quandary, your PSA is indicative activity, the scan Shues "nothing" though we know given it's sensitivity, it may miss micro metastatic disease too small to be seen.

If the latter is the case you then face a decision, act solely on the PSA or repeat PSMA PET in the "future."

I have seen some literature that points to those with high PSA doubling and velocity times, PSMA PET scans are more likely to show activity because of the avidity.

You can plug your numbers into MSKCC's nomogram to get your doubling and velocity times.

Kevin

I was Gleason 9. Had surgery 11/11/24 at age 67 and found some adverse factors - bladder neck invasion, cribriform and some others. PSA was 0.02 at 6 months, 0.04 at 11 months. Even though I was well below the 0.2 threshold the radiation oncologist felt we were trending the wrong direction. I had a Lupron injection in October 2025 and 39 radiation sessions ending in February. I was undetectable in March and have my next test in 2 weeks.

Even though the PSA was still low I was glad we moved ahead aggressively. Damn the side effects - and I HATE the hot flashes - full speed ahead.