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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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Gleason 9, Grade 5, initial stage 3ab, 10% Crib one biopsy pin, contained to gland
No seminal invasion
No lymph invasion
Surgical margin clean, so he stated.
Post surgery stage reduced to 2ab
I would wait 6 months to see where you are on your PSA. At my 6 month test, 0.04, it rose instead of falling, he stated undetectable and I threw the mental BS flag base on his subtle look. My PSA should have been undetectable (0.0146) at that point if surgery worked. Which by the way I am 0.0146 1 year post radiation for a year now. Took 4 years to get to that cigar.
@drcopp
Different labs have different Ultra sensitive limits. I know one lab has a limit of .006 others .002 or .001 which of course what people want to see. What’s much more important is whether or not it rises and how quickly it rises.
@melvinw Very similar to my case. In 2015, I was 68 at the time when I had the surgery. The PSA remained at 0.05 for 14 months after the surgery until it rose to 0.09, then 0.14. At this point I was given 40 radiation sessions and on Lupron for 6 years. In 2019 my cancer was diagnosed as terminal stage 4 with a survival of 4 years. My PSA from 2017 to 2025 was about 0.30. Since I was still alive, in August 2023, I asked my oncologist to stop medication until the PSA raises to 1. He accepted. My last PSA was 0.68 and my oncologist ordered a PET scan for this August.
I hope this chronological information helps you to get any idea.
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2 Reactions@jeffmarc wrote " I know one lab has a limit of .006 others .002 or .001 which of course what people want to see."
What labs do you know that have limits of detection down to .002 or .001?
To the best of my knowledge, there are no commercial labs running automated uPSA tests that have a lower limit of detection than LabCorp's .006. To get lower than that, you need a manual assay done in a specialized laboratory, and that's not typically an option for patients.
Thanks Jeff. I just wondered how low the acceptable instruments measure down to, gives me an idea of the amount of error that would be acceptable.
@drcopp
I don’t think you can ever get down to zero as some believe as your body in other glands produce very very small amounts, not anything significant but likely read super ultra sensitive tests
@notpetecrowarmstrong
I’ve seen people reporting .001. I haven’t kept track of what Labs have such low Tolerances.
@jeffmarc
Barring a specific citation, I think we should assume those people reporting a detected PSA of .001 may be mistaken and readers here should not take this as reliable. That's way lower than any automated test system I've ever seen.
LabCorp's limit of blank is 0.006, its limit of detection is 0.010, and its limit of quantitation is 0.014. Those are the lowest limits, respectively, of any widely available uPSA test unless your sample is being handled via manual assay for research purposes.
@drcopp My lab lower limit is 0.0146. I wouldn't worry about lab errors or contamination unless you had a real outlier of a number. Then you simply get retested with a lab that uses the same equipment or the same lab. Different analyzers have different ranges so you would want the same type that you have been using all along. We can become obsessed about some of this stuff, and it causes us to miss the gifts of today.
I was similar. Higher Gleason etc. Mine was 0.04 after robotic. After it more than tripled to 0.38 I had 40 proton treatments and went on Orgovyx a month before starting radiation. The radiation was completed about 3 months ago and the Orgovyx will finish at the end of July after being on it for 1 yr.
My PSA has been consistent for the last three month at 0.04 so I am thinking that is my new base line (nadir)