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Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?
I have been fortunate enough to experience PSA results of <.01 post prostatectomy. Now, at the 6 year mark, I have had a result of .02. I realize this is not a huge amount, however, wondering if anyone else has had this experience and what to expect going forward. I was very high risk at T3b, SVI, ECE, PSA 11, PNI, 4 +3. Wondering if I should expect a rapid increase now that it has reared it's ugly head? I have been very blessed so far. I would appreciate hearing from anyone else who has had similar experience. Thank you. Tom
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This Sub is very relevant to me and my prostate cancer diagnosis. I have provided my pathology and testing history below. In summary, I am presently watching my PSA very carefully and if I see a confirmed upward trend in PSA - i.e., at least three consecutive rises in PSA and/or it reaches 0.1 ng/mL, I will be consulting with my radio oncologist about early salvage radiation treatment and probably a 6-12 ADT. It’s noteworthy to point out that my radiation oncologist told me 8 weeks after surgery, with my pathology he would do adjuvant radiation - “if that’s what I felt was best for me” - He didn’t really recommend adjuvant therapy, but rather said say he would do it - if I asked for it… MY POST PROSTATECTOMY PATHOLOGY & POST OP PSA TESTING SUMMARY:
Post surgery Pathology confirmed Gleason (4+3) - no change from pre-surgery biopsy. Surgical pathology indicated 4 positive margins - both seminal vesicles invaded showing positive margins, and positive margins on the bladder neck and a positive margin on the prostate tissue removed <3mm in size. No lymph node involvement. My complete staging is now: pT3bN0MX. R+, <3mm, p3.
My Decipher Score on biopsy tissue is 0.89. My PSA before surgery was 13.3 on 4/8/25 rising to 17.8 on 9/4/25. Surgery was 9/22/25. My post Prostatectomy PSA history is
POST OP Ultrasensitive PSA Test #1, 10/29/25, RESULT = 0.03 ng/mL.
POST OP Ultrasensitive PSA Test #2, 12/25/25, RESULT < 0.006 ng/mL (below detection)
POST OP Ultrasensitive PSA TEST#3,
04/08/26: 28-Week/ 198 Days (~7.5 Months); RESULT = 0.010 ng/mL.
POST OP Ultrasensitive PSA #4, 06/03/26: 36-Week/ 254 Days (~9.0 Months); 8-weeks after Test #3. RESULT = 0.010 ng/mL.
POST OP Ultrasensitive PSA #5, 08/26/26: 48-Week (~11 Months); 12 weeks after Test #4.
RESULT = 0.018 ng/mL.
** This rise concerns me, and I plan to RETEST Monday 9/14/26.
@jeffmarc
Hello Jeff. We have chatted before. Your point is very true. However, IMO, if the test results continue to rise consecutively, I think it’s valid to be concerned - regardless of whether the test is Ultrasensitive, or not. IMO, repeated results showing an uninterrupted upward climb in PSA can only mean one thing. *And yes, my results are all from the same lab, using the same test protocol, and all blood samples were taken at the same collection clinic (consistency is critical to test results being comparable).
@esperling Re-testing this week sounds like a good plan. For what it's worth, I have found that my own uPSA fluctuations at similar low levels (bouncing around between 0.008 and 0.016) seem to correspond at least partially with how well hydrated I am. I now make it a point to try to stay as hydrated as possible in the two days before my test and the day of.
It's great that you have an RO who is so open to discussing and working with you on an approach that's specific to your personal situation.
Best of luck on the re-test.
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2 Reactions@esperling
3 1/2 years after my prostatectomy, my PSA hit .2. I have BRCA2, which makes my cancer much more aggressive yet it took that long to come back. I had salvage radiation at that time.It has come back three more times since then.
This Started 16 years ago, so there were no tests like decipher or ArteraAI. If they had been, and I saw a .89 I would be worried, but the fact is, treatments today really work great. Yes, you have positive margins but your PSA isn’t rocketing up .
You’re a perfect example of somebody who’s probably going to have this as a chronic disease not a deadly disease. The drugs we have are so good and you haven’t even had radiation yet. This is just a matter of waiting for the next series of drugs to come out that will allow us to live even longer than the ones we currently have.
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5 Reactions@notpetecrowarmstrong thanks for the tip on hydration! I’ll make sure to get on drinking the water now - I may have to put off the blood draw until Tuesday anyway. Appreciate the advice.
@jeffmarc thanks for that advice - and you are right on. I know it’s likely going to be a long haul battle with this and I’m prepared for it. I stay very lean and fit and work on good nutrition, rest and once I retire lower stress as well. For me it’s critical to stay on top of testing, and researching what new treatments are available and the latest studies on what seems to work and what doesn’t as well. Each of us is an individual with our own cancer to fight and it takes full engagement to give it the best fight you can. Appreciate the wise words my friend. Best of luck to you in your continued journey and battle. Thanks.
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2 Reactions@esperling That surgical pathology report is pretty indicative of the need for a more aggressive approach, IMO…namely SRT with ADT sooner rather than later.
Remember, PET is not as sensitive to micrometastases as we would like to think, so showing ‘no spread’ is not something we can bank on. Best,
Phil
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1 Reaction@esperling
I understand your concerns and wish you the best possible outcome. We do have similar high-risk biology and pathology, except that my surgical margins were negative.
My surgeon does not track PSA at the ultrasensitive level like yours does, so at the one-year mark after surgery, my fourth consecutive PSA test was reported as “undetectable,” meaning <0.02. It’s possible that an ultrasensitive test might have detected a low but measurable PSA and provided information about its trend or doubling time, but I have no way of knowing because of the type of PSA testing I’ve been having.
That is one of the reasons I plan to consult with a radiation oncologist very soon—to discuss whether ultrasensitive PSA testing would be more appropriate for my situation and how best to monitor for a potential recurrence.
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2 ReactionsI think a 0.01 or even 0.02 is still very low and would allow sufficient time for salvage treatment to be effective, and there is the potential additional anxiety of data variability at the ultra sensitive level, but for me, I want to know at the very earliest hint of BCR to allow me ample time to thoroughly consult oncology specialists and come up with the optimal EARLY Salvage treatment for me and my cancer.
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3 Reactions@heavyphil
Thanks Phil. You are spot on in your assessment and that’s why I watch my PSA VERY CLOSELY. I am prepared to go on the attack again EARLY should I have validated signs of a recurrence. Given my pathology and Stage, I expect the best salvage treatment plan will include both SRT and ADT.
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