Is PSA 0.032 after radical prostatectomy a normal fluctuation?

It very likely is just fluctuations. You do not appear to have aggressive cancer which is more a predictor towards a fast BCR. Your final pathology appears as excellent. I would imagine a continuation of regular PSA testing. My oncologist is a firm believer not to do ultra sensitive testing unless it was warranted by very aggressive cancer, or other factors regarding the cancer as he says because of fluctuations even a tiny one with ultra sensitive can be regularly seen and patients will say my psa is doubling from a .01 to .02. Hec says even doubling at the very sensitive levels unless for other factors is not a concern with how low the reading is. He uses a lab with the less than <.04 non detectable for it’s threshold. He acknowledges that it might be going up and won’t show for a year or two going up very slowly and until doubling rate is something tangible and immediately would begin to be monitored once it went over .04. BCR is considered.2, so it could take time and instead of patients overwhelmed with anxiety and concern awaiting monthly or quarterly ultra sensitive scores he prefers the others for most his patients which he said is fine. It would get caught soon enough at the quarterly or semi annual tests if the .04 threshold is kept. He said he sees all the time patients overly concerned and filled with anxiety over their PSA scores asking about the ultra sensitive tests. It is difficult for people to accept this when they think there is a better test, but he says ultra sensitive tests play a role but not for most patients. A couple years of stress free life is pretty good. If and when (next month 2 year PSA test post surgery) will begin to stress and get concerned about future treatments.

While it is a doubling rate. It is pretty slow and right now. It is really low.

They do not recommend doing anything after a prostatectomy until the PSA hits .2. You are significantly below that level.

The National Cancer Institute says not to worry about small changes in PSA when your PSA is that low.

Keep track of it and see what the doubling rate is. Currently, it is taking quite a long time to double, And it is so low that you really don’t want to get concerned yet. This is one of the problems with ultra sensitive PSA, People get so worried when a fractional PSA starts to rise fractionally. I’ve always kept my PSA reading to one Decimal point that way I don’t get concerned about these issues.

Back in the “old days” after my prostatectomy (2015), I only got standard PSA tests (what my urologist ordered). I was undetectable for tens years, which meant <0.1. My doc would call me, say “PSA is undetectable” and I never gave it a second thought.

These usPSA tests have their place, but they can make you crazy with undue worry. Although they go to three decimal places, they can bounce around due to “lab variance” (the sample, the instrument, and the instrument oeprator). The uptick in your usPSA from 0.023 to 0.032 looks within the range of lab variance to me. As Jeff said, keep testing though, watch for an upward trend and any doubling time.

I underwent salvage radiation for a local recurrence last fall. In the six months following, I’ve had four usPSA tests with the results as follows: 0.086, 0.113, 0.100, 0.090. The average of these values is 0.097 (“undetectatble” relative to a standard test). Anyway, you can see how these values have bounced around. I was a bit concerned when it went from 0.086 to 0.113 (an increase of 0.027), but it didn’t keep going up. As my urologist said, my PSA is "low and stable”. If it stays like that with, some minor up and down variations, I’ll be satisified. No need for further treatment.

So indeed, everything both Jeff and wheel1 said is spot on.

I would do uPSA test every 3 mos and see if there is any further upward trend. There is a study that compared uPSA trends and values and they concluded that if uPSA ever reaches 0.03 it is a predictor of eventual BCR.
BUT, that is one single study. However, if it was me - I would start checking it every 3 months for some time.

Will your insurance cover extra testing at this level?

The second year after surgery the PSA tests by the surgeon for most are semi-annual if continued undetectable to the reporting lab threshold they use. With your favorable position you could ask not to have the ultra sensitive and get a <.04 undetectable with your next PSA. If it were then to rise from .032 to a level still under .04 undetectable you could probably continue with that at semi annual. At that point all you would know is that it was under .04, maybe even below .032. If it was rising at a concerning rate it would exceed .04 anyway so the ultra sensitive would not have mattered. Stress and anxiety are contributing factors to alot more other illnesses and deaths. The less you have your overall health can improve especially if nothing would change at the present time. Many people get full body MRI’s out of fear they have some unknown illnesses. I suppose everyone could go get one and find something.

@marlon

If you are asking about PSA - test is ablut $65 without insurance in LabCorp or WalkInLab etc. My husband ordered tests every month for himself since he did not want to depend on doctors and it proved to be great strategy for him. (My husband was high risk patient).

I had very similar results after my robotic prostatectomy although I did not have a large prostate or a TURP beforehand. Also, I was 64 and not 53 when I started this journey. My Gleason score was 3+4=7. After surgery all was well. My PSA’s were undetectable for 4.5 years. The lab I initially used used to give values until it got to over 0.04. Then that lab was bought out and the new lab just reported “<0.1 wth verbiage that stated based on the AUA below 0.1 is undetectable. So after 4.5 years after surgery my last psa came back as 0.1!! I insisted on an Ultrasensitjve psa and that came back as 0.128. I will be starting Early Salvage Radiation on the middle of August. Don’t worry until it gets to .1 (hopefully it won’t) Becallo be your own advocate too. Good luck.

@jamie1957

Not sure what Becallo is but meant to type Be your own Advocate!?

I will echo Surf's comment. Her husband and I have very similar aggressive characteristics. I had a Decipher test on biopsied-tissue before RALP and it was .89; it was later upgraded to .96 after surgery (post-surgery pathology also confirmed other aggressive characteristics).
My surgeon did not recommend the ultra-sensitive test for my 3 month test when I asked him. The result was <0.1--non-detectable, so I was happy.
After reading a lot of comments in this forum I got only ultra-sensitive tests going forward. My next result was 0.171. I started monthly testing and it kept rising.
I am now in the middle of radiation treatment and taking Zytiga/prednisone and am on the estradiol patch. Due to how long it takes to get everything lined up, by the time I started treatment I had hit a high of 0.215--not ideal as starting treatment at 0.2 or lower has better outcomes.
Would that first reading have showed something was there (i.e., it was NOT non-detectable) if I had the ultra-sensitive test? I don't know. But if so, I would have had a head start on getting treatment lined up and a better shot at starting treatment below 0.2.
I fault my surgeon and my RO. Their reaction to the Decipher scores was "well, this confirms it's aggressive." Neither said, "and now you have to be vigilant by getting the ultra-sensitive test and testing more frequently," although my RO said I had a higher likelihood of recurrence.
Since you don't have aggressive cancer, this doesn't apply to you and I support others' comments re: timing and inconsequential changes driving you crazy. But for those with aggressive cancers, I would err on the side of more testing with the ultra-sensitive test.