Frequency of PSA Test

@azp52
Your doctors really missed it. When your PSA hit .1 they should’ve switched to monthly tests. At .2 they should’ve considered you’re getting salvaged radiation, And if it rose any higher, that was definitely needed. Salvaged radiation would’ve taken care of your lymph nodes as well.

Here are the guidelines for when to do salvage radiation and they really show your medical team. Let you down dramatically. Your doctors did not follow the standard of care. You need to find yourself another medical team maybe move to a different place that’s a center of excellence, and get a second opinion on what to do now.

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

@jeffmarc

I agree and my personal opinion is that all high risk patients (one with high gleason, aggressive elements in biopsy and any suspicion of EPE, PNE, or positive margin ) should be EXTRA vigilant and have PSA testing more often than "regular" patients.

High risk patients have high risk for BCR , also getting it sooner and again probably as fast growing, so having protocol moved to every 6 mos is abomination, IMHO. It is a cheap test and yes - please everybody try to get ultrasensitive tests if at all possible. :(((

@rlpostrp

Your doctor simplifies explanation of cancer cells to the point of me questioning either his honesty or his knowledge O-0 !!???

Cancer cells detach and travel through body ( obviously without any blood supply and no, they do not crawl - they can travel long distances) and attach to different places. Once when they attach they form their OWN capillary system and extensions that make connections with blood supply ( process of angiogenesis). They than divide and multiply and form their own colonies (tumors) and happily have all that they need inclooding ability to grow and divide in accelerated manner.

I learned that when I was a biology student, so I have no idea what your doctor is talking about . If his words were true than no BCR would ever happen. All those features that they look for (EPE, PNE, positive margins etc etc ) are considered "high risk" for a reason.

Thanks for the reply. I used a more generic/common word "crawl". I was a Director of Clinical and Anatomic Pathology, and have two undergraduate degrees in Biology: 1) Cellular and Molecular Biology, and 2) Clinical Lab Science. I was around this stuff for 40 years. Cancer cells - some not all - extend what are called "pseudopods"...extensions of their cell membrane and cytoplasm to sort of "pull/inch their way" where they are heading. No one knows if they "sense" blood supply or anything else they want in order to support their survival and growth, but they do move around without blood supply to carry them. Here is the "AI" search definition I just looked up: "Pseudopods play a crucial role in cancer cell invasion and migration. These are temporary, foot-like extensions of the cell membrane that allow cancer cells to move through tissues and penetrate barriers, facilitating metastasis." That is what I was getting at when I used the more common term "crawl." Thanks for the opportunity to clarify for everyone.

@jeffmarc Yes, Jeff, they definitely missed it, and I did too. I always checked the numbers myself after each draw, but during that time, I was going through several unrelated surgeries due to a serious injury. It was about six months later that I noticed the PSA number of 0.1 while I was reviewing my results and entering them into a spreadsheet. I called my doctor, and one of the assistants informed me that it was normal. However, this assistant was referring only to the lab report, which indicated that my PSA level was within the normal range, as shown by a "green" code. There was no "red" color to signal a potential issue. Clearly, when the doctor received this report, the assistant reviewed it, saw it marked as "green," and filed it away. The assistant did not know and/ or did know and failed to take into account that I had prostate cancer and was two years post-radical prostatectomy.

To add to the situation, the urologist I had been seeing retired. I live in a rural area where, to this day, we do not have a urologist or an oncologist. As a result, I was seeing a general practitioner who was familiar with my history and was simply monitoring the PSA levels. When lab results arrive at the office, the assistant reviews them. If they are marked as "within normal range," they call the patient to inform them that everything is normal and then file the results.

I don’t mean to excuse the doctor's office for this oversight, but I do wonder why the labs don’t have a system in place, like a "check box" to automatically alert for PSA levels of 0.1 or higher for patients like us, where a PSA level of 0.1 is an issue. This would trigger a "red alert" on the lab report for any result that is 0.1 or greater. In my case, such a visual cue could have served as an additional safeguard, prompting the assistant in the doctor's office to take immediate action.

Thank you, Jeff, for your information!

@smoore4 Well, really. It misses out the all-important head-banging community.
Jay Jay French of Twisted Sister & Rob Halford of Judas Priest.

@koji480
We need to do what is best for us as an individual. I am approaching my 3rd year after radiation. The time frame given to me by UHFPTI was going to be longer than every 3 months as the time frame went on and no significant issues with my PSA numbers (I had proton only no hormone).

However my Mayo PCP and I have agreed as a team that we will do the test every 3 months because we both want to see any significant changes that we may need to address.

Our mental health is just as important as our physical health. And for me my PCP recognized that and supported continuing to order my PSA tests every 3 months. My last test was .12

That is down from the 3.75 at time of diagnosis. You can see a normal PSA does not mean you don't have PC nor a high one meaning you have PC.

@peterj116 A **glaring omission**!! I will fix that. Just goes to show you how diverse this forum is...

I recently went through 38 IMRT treatments and you see a lot of people come and go during that time. What a mix of different personalities, ages, and tbh situations in life. Met some really great people, and we were all like a band of brothers as I saw it. No weirdness talking about the most intimate of things with people I'd only met 15 minutes prior.