The doctors usually want to do it When the PSA hits .2. The fact that yours has not hit .2 could allow you to wait. I would want monthly blood test to see what’s going on. If you don’t treat it soon after .2 there are problems, Though some doctor say, wait until you can see the metastasis and zap them.
You don’t mention how quickly your PSA went from .04 to .1. Some people get six month tests and that makes it hard to evaluate. What’s going on when it starts to rise.. They want to know the doubling rate and the numbers you provided don’t really give enough information for timing.
ASCO, which sets the standards for prostate cancer treatment has posted the following.
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.
Now that you've had 2 PSA increases in a row your Doctor will probably order a PSMA pet scan. If they don't see anything in this scan they'll probably order SRT to the prostate bed and possibly the pelvic lymph nodes. ADT probably not necessary, but depends maybe on your surgery pathology report. Sorry to hear about your rise in PSA. I would definitely request another PSA a month from your last test
If you are going to have radiation, you may want to try and limit your side effects with an MRI guided radiation machine, which would be either the Mridian or the Elekta Unity.
The advantages are lower toxicity, better soft tissue visualization, adaptive planning and more accurate treatment as what they can see in real time, they can treat. Fused images used with other types of radiation machines are not the same or as effective.
Now that you've had 2 PSA increases in a row your Doctor will probably order a PSMA pet scan. If they don't see anything in this scan they'll probably order SRT to the prostate bed and possibly the pelvic lymph nodes. ADT probably not necessary, but depends maybe on your surgery pathology report. Sorry to hear about your rise in PSA. I would definitely request another PSA a month from your last test
I am 10 yrs post surgery. I was a 4-3, T3a. Zero PSA until yr 8, then .1. Last three PSA's were .4, .5 and .5. Two clean PSMA scans. My urologist is not recommending radiation until we know where it is, a recommendation I agree with, though he thinks most likely spot is the bed. There does seem to be support to radiate even with with a negative PSMA. https://pmc.ncbi.nlm.nih.gov/articles/PMC10774185/
I believe the sooner after surgery your BCF occurs the more aggressive your approach should be. My doc is basing his recommendation on the fact that it took 9 yrs for my BCF.
Good luck
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First, sorry you had to find your way here. A couple of questions.
1) How long in between the .04 and 0.1?
2) Dr wants to do radiation where? Did you have any scans to identify locations of possible recurrence?
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1 ReactionThe doctors usually want to do it When the PSA hits .2. The fact that yours has not hit .2 could allow you to wait. I would want monthly blood test to see what’s going on. If you don’t treat it soon after .2 there are problems, Though some doctor say, wait until you can see the metastasis and zap them.
You don’t mention how quickly your PSA went from .04 to .1. Some people get six month tests and that makes it hard to evaluate. What’s going on when it starts to rise.. They want to know the doubling rate and the numbers you provided don’t really give enough information for timing.
ASCO, which sets the standards for prostate cancer treatment has posted the following.
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.
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Hug
2 ReactionsSix months between blood works no more scans yet PSA was 003 then up to.04 now 0.10
Also I had a scan with contrast after surgery about a month or two told I was cancer free
Going to my first consultation with the radiologist next week any tips
You may find this interesting.
https://www.auanet.org/guidelines-and-quality/guidelines/salvage-therapy-for-prostate-cancer
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Hug
5 ReactionsNow that you've had 2 PSA increases in a row your Doctor will probably order a PSMA pet scan. If they don't see anything in this scan they'll probably order SRT to the prostate bed and possibly the pelvic lymph nodes. ADT probably not necessary, but depends maybe on your surgery pathology report. Sorry to hear about your rise in PSA. I would definitely request another PSA a month from your last test
-
Like -
Helpful -
Hug
2 ReactionsIf you are going to have radiation, you may want to try and limit your side effects with an MRI guided radiation machine, which would be either the Mridian or the Elekta Unity.
The advantages are lower toxicity, better soft tissue visualization, adaptive planning and more accurate treatment as what they can see in real time, they can treat. Fused images used with other types of radiation machines are not the same or as effective.
-
Like -
Helpful -
Hug
3 ReactionsThanks
I am 10 yrs post surgery. I was a 4-3, T3a. Zero PSA until yr 8, then .1. Last three PSA's were .4, .5 and .5. Two clean PSMA scans. My urologist is not recommending radiation until we know where it is, a recommendation I agree with, though he thinks most likely spot is the bed. There does seem to be support to radiate even with with a negative PSMA. https://pmc.ncbi.nlm.nih.gov/articles/PMC10774185/
I believe the sooner after surgery your BCF occurs the more aggressive your approach should be. My doc is basing his recommendation on the fact that it took 9 yrs for my BCF.
Good luck
-
Like -
Helpful -
Hug
3 Reactions