First detectable uPSA since surgery 14mos ago

They usually do salvage radiation at .2. You may have a long way to go, PSA can bounce around a little, give it some time. Below .1 is considered undetectable, your .014 is way into the undetectable range.

Thanks for the input.

Also wanted to pass along the latest AUA/ASTRO guidelines from 2024 for handling recurrences.
https://www.auanet.org/guidelines-and-quality/guidelines/salvage-therapy-for-prostate-cancer

My team felt the right thing to do was start salvage radiation after two rising PSA blood test, this was at 0.039.

The docs felt that if the trend is established, it's probably time. I had a blood test after the decision was made and between the one that was 0.039 and marker insertion and tattoing, that came back as 0.091. So it was the correct decision for me.

We did it, looking back, I don't regret it.

I suggest not to do anything unless it reaches.2. Radiation will kill it and also kill the good cells too. There is a price for radiation in the long term.

Well, you certainly can start SRT...you can also wait until you have more definitive clinical information.

Those are good guidelines - https://www.auanet.org/guidelines-and-quality/guidelines/salvage-therapy-for-prostate-cancer

I guess the question is, what are you and your medical team going to do as there are choices depending on how aggressive you want to be.

SRT to the prostate bed only.
SRT + Short Term ADT
SRT to the Prostate Bed + WPLN
SRT to the Prostate Bed + WPLN + Short Term ADT

Imaging likely cannot help in your decision at that PSA so the choice may be based on other clinical data, GS, GG, time to BCR...

When I did SRT in2016, the standard of care was SRT to the prostate bed only. Data was emerging but not yet into clinical practice that for high risk PCa, adding the WPLN and short-term ADT was the likely "best" choice. My SRT failed, my instinct told me to do the prostate bed and WPLN and short-term ADT, I let my medical team talk me out of it, sigh.

Kevin

Also hoping it is a blip for you.
You are asking a very specific Q, and did so in Sept 2024, and truthfully you appear to be knowledgeable and know the probabilities; just not the specific time line for you.

And no one knows for sure.

A friend had RP about 5 yrs ago (and no, I do not know all of his numbers). Similar to you, he was undetectable at the very low 3 digit number range (and i infer that it may have been Lab Corp testing).
2 yrs ago, he began to have some detectable readings and now, 5 yrs after RP, he is beginning Salvage Radiation Treatment to the prostate bed and pelvic lymph nodes at a MD Anderson affiliated location in NJ w/ a PSA of about .2 ish, without ADT.
That is the closest situation to yours that I know.
My PSA was a persistent .19 following RP, so with G 9 and EPE, I went "immediately" to Salvage Treatment WPRT to pelvic area and pelvic lymph nodes w/ 4 mos ADT, did not pass Go and did not collect $ 200.

However, thankfully, uPSA results have been < .02 (limit of detection for Quest Diagnostics) for 1 year post tx.
And like you, and others here in Casablanca, I wait and wait...

Personally, I have stopped trying to compare, because after RP (or RT) as primary tx, we all seem to progress differently and we can only hope, and pray, for continued good results for ourselves and all of our fellow travelers on this similar but unique journey.
Sincere hopes for your numbers to remain ultra low and not ready for additional treatment.

Thanks for those guidelines - very helpful. I totally understand your dread and sense of inevitability ….that was me about 2 yrs ago.
But no matter your risk profile according to Gleason, etc., the new guidelines still recommend .2 as the definition of BCR. You are really far from that at .014…
Now the thing to watch is the velocity of any PSA increase since that is a pretty good indicator of how rapidly growing any cancer cells may be. Normal prostate cells left behind as part of nerve sparing procedures, or Cowpers gland cells do not produce rapidly accelerating PSA - only cancer does that.
Also remember that PSMA scan doesn’t really show much below PSA values of .5 so no great rush to have that done either. Enjoy NO treatment while you can!🤗

Thanks for this and the other detailed responses. They are all much appreciated.

Yes, I’m knowledgeable. Maybe some Dunning-Kruger effect but I’ve spent a lot of time researching in the last 18mos. I’m also a probability guy and a worst-case-scenario guy, as a result of the nature of my job.

I meet with my surgeon tomorrow for what was supposed to be a “looking great at < 0.006” first annual visit post surgery. But now that has changed slightly. I’ve already gotten the text from his medical assistant: “PSA undetectable at < 0.1. We will test again in 4-6 months.” First off, it isn’t undetectable. Second, no way I’m waiting 4-6 months for another test. I’m gonna have the what-if discussion with him tomorrow. My plan is likely going to be talk to a rad-onc once I hit 0.05 and then start radiation when I get to 0.1 unless they recommend sooner. If you hit 0.05, you are gonna hit 0.1, so I don’t see much point in waiting. I did have positive margins, so one benefit to that is that in increases the odds that the recurrence is in the prostate bed. Still a decent chance that it may be elsewhere, but doing the bed plus whole pelvis radiation plus short course ADT really does predict a good probability of success for long remission. I’m only 54 so I’d like to take the best shot at a cure if it comes to it.

I started thinking about the Cowpers Gland cells and their propensity to produce PSA. I couldn’t find much on it in terms of levels but 0.014 seemed like to high of a level for the Cowpers, just from a common sense perspective. I did have sex less than 8 hours before the test and an another time 24hrs before that, as that function has finally returned nicely. lol. However, I know I don’t have a prostate to elevate the number but was wondering if the Cowpers could be activated to do such a thing so close to a test. “Looking for excuses for an elevated number, he is.”

Patience you must have my young padawan.

My layman prediction FWIW:
Repeat uPSA 30 days after last test.
Test every three months.
If rise continues, then Salvage Radiation Treatment should be considered (see web265).

Moving forward you are; patience you need.