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Is PSA 0.032 after radical prostatectomy a normal fluctuation?
After radical prostatectomy and PSA 0.032 ng/mL: normal fluctuation or concern for recurrence?
Hello. I would like your opinion regarding my course after radical prostatectomy.
I am 53 years old. Initially, I underwent a TURP (transurethral resection of the prostate) because of severe benign prostatic hyperplasia. The pathology from the TURP unexpectedly revealed prostate adenocarcinoma, Gleason score 6 (3+3), confined within the prostate. The cancer foci were small (ranging from less than 1 mm up to 4 mm). Overall, the carcinoma was estimated to involve less than 10% of the total tissue removed.
Following the recommendation of my urologists, I underwent a robotic radical prostatectomy.
The final pathology report showed:
Gleason score 6 (3+3), Grade Group 1.
Multifocal carcinoma with several distinct foci, mainly located in the anterior peripheral zone of the right lobe and the right bladder neck region.
No involvement of the prostatic apex or seminal vesicles.
The largest tumor focus measured 0.9 cm.
Approximately 7% of the prostate was involved by cancer.
The cancer was organ-confined.
Pathological stage: pT2.
Negative surgical margins (R0).
Seminal vesicles were free of cancer.
Both lymph nodes removed were negative for malignancy.
My PSA course after surgery has been the following:
40 days after surgery: 0.158 ng/mL
5 months later: 0.023 ng/mL (same ultrasensitive PSA assay)
10 months after surgery: 0.032 ng/mL (same laboratory and same assay)
My question is:
Based on my final pathology and this PSA trend, would you consider the increase to 0.032 ng/mL to be a normal biological/laboratory fluctuation, or would it raise concern for persistent disease or biochemical recurrence? Would you recommend any additional investigations or a different follow-up strategy?
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40 days after the surgery your PSA was 0.158 and 5 months later it was 0.032. In my opinion, this is perfect. 6 in the Gleason scale is low. Some oncologists treats it without surgery, especially when you are so young. Usually they operate when the scale is 7 and above. I am 80, my cancer is stage 4 and I am okay 11 years after my surgery. My PSA is 0.68 now.
Don't be afraid, your prognosis is not bad. Follow your medical team advice.
Good luck
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1 Reaction@amota
Thank you very much for your encouraging reply. Just to clarify, my PSA was 0.158 at 40 days, then 0.023 at 5 months, and 0.032 at 10 months after surgery.
If you don't mind me asking, did you receive any additional treatment after your surgery because of your stage 4 prostate cancer, such as radiation therapy or hormone therapy?
@pavlos My surgery was in September 2015. In May 2017 there was a cancer recurrence and I was given 40 radiation sessions. After that, I was on a continuous hormone therapy. On August 2019 my cancer was diagnosed as incurable stage 4 with with 3 to 4 year s survival. Still alive, in August 2023, I asked my oncologist to suspend the hormone therapy, he accepted. Now, my last PSA was 0.68 and a scanning is scheduled for mid August.
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2 Reactions@jamie1957 Our stories are not all that different. RARP when I was 62 (2015). Gleason 3+4. I was undetectable (<0.1) for ten years. Then in June 2025 my PSA hit 0.11. I also had a nodule in my prostate bed that lit up like Christmas tree on a PSMA PET scan, but no mets beyond that were detected. I did 38 sessions of salvage IMRT (both prostate bed and pelvic lymph nodes) last fall (Sept-Nov). I did an usPSA test just before starting therapy that yielded 0.097. The IMRT went pretty well with only a few hiccups, and I haven’t had any lingering serious side effects, so far. PSA really hasn’t dropped yet. As I stated in a previous comment, I’ve had four usPSA tests since RT and they average to 0.097, with min of 0.086 and max of 0.113. Not what I expected, but I’ve since learned that it can take 2-5 years for your PSA to bottom after RT. My RO and urologist are not oncerned at this point, so I will just continue with quaterly PSA test and see where it goes. My optimistic interpretation is that the cancer is indolent (ten years before recurrence supports that), and if so the cancer cells are not dying from radiation damage because they are not dividing much. Whether my interpretation is right or not, I took the path of early intervention, like you, aiming for a better outcome than if I waited to hit 0.2.
Anyway, best wishes to you going forward with your salvage RT. “Full bladder and empty rectum” will be your daily mantra for a while.
Mel
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2 Reactions@melvinw
Thanks Mel. Good to know. Although I don’t think that the Radiation Therapy will be a walk in the park, I am pretty confident that I will handle it just fine. No talk of ADT so that’s good. I did not know that it could take a few years for the PSA’s to go down after RT so that is good to know too. I trust my Surgical Urologist and my RO so although I may have questions along the way, I am pretty comfortable with their assessments at this point. Thanks for the information.
The laboratories detection limit can vary a bit on any particular day.
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1 Reaction@jamie1957 if you’re concerned about the radiation therapy, I’ve had 35 rounds of proton radiation three years later 25 rounds of IMRT both were a walk in the park.
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1 ReactionMy lowest PSA after RP was .03. At 6 months .04 and when my OS stated undetectable I sensed this wasn't good and was pretty sure I had a problem. In a perfect world your PSA should be undetectable or at least trending down over your first 6 months. Much different than if you had radiation. Radiation sucked. ADT was tolerable. I found staying in today rather than projecting was helpful. Good luck and make sure to ask your doc questions.
Does the ultra sensitive PSA test have limits on how low it can detect? I have read that lab errors, contamination, etc. can cause its accuracy less than 100% perfect.
@chippydoo "Thank you for sharing your experience. May I ask what your final pathology was? For example: Gleason score, surgical margins (R0 or positive), stage (pT), lymphovascular invasion, seminal vesicles, and lymph nodes? I'm asking because my pathology was Gleason 3+3, pT2, R0 with negative lymph nodes, so I'm trying to understand whether our situations are comparable."