High-risk recurrence at PSA 0.1 rather than wait for 0.2?

Here’s the opinion about this from a well respected Genito Urinary Oncologist

Adjunct radiation
Dr. Efstathiou concluded as follows:b
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

am now 1 year postoperative.
My pathology shows Gleason 3+4, unilateral seminal vesicle invasion (pT3b), and cribriform pattern positivity.
Over the first postoperative year, my PSA has increased from 0.02 to 0.05.
In this context, should one still wait for the classical PSA threshold of 0.2 to define biochemical recurrence and initiate salvage radiotherapy,
or in high-risk features such as pT3b disease and cribriform pattern, is earlier intervention at PSA levels like 0.1 or 0.15 recommended?

Does anyone have experience with initiating radiotherapy at these lower PSA levels in similar cases?

Jeff Marchi summed it up pretty well; so yes, you can pursue treatment earlier than PSA 0.2.
Also, since you are at .05, a PSA test every 3 months is recommended; if you see a steady increase to 0.1 in a short time frame (less than 6 mos) it would be advised to start salvage therapy with ADT.
Phil

Short answer: Yes
Postop I was: PT3aNoMx Gleason 9 EPE
1st PSA .19
Referred to RO who initiated salvage radiation treatment (SRT) to whole pelvic region (WPRT) together with pelvic lymph nodes (plns).
Gratefully have been undetectable < .02 for more than 2 years since.
Also, I recall another MCC member had low, rising PSA post-op less than .2 (he was .1 or .15 range I believe) and SRT was initiated. He may have been G 7
Layman here, however in consult with your RO, it may be prudent to begin to plan for SRT.
Best wishes.

@heavyphil I believe velocity is the trigger. After my first year I doubled every 6 months.

Basically earlier treatment gets labeled "salvage radiation" and is not triggered by rises in PSA but rather by other factors observed in the pathology, such as those listed, so you might want to search for salvage radiation to find this rather than thinking of it as a second intervention. I think "adjuvant radiation" and "salvage radiation" likely refer to the same thing--adjuvant to radical prostatectomy or salvage to catch cancer left behind after prostatectomy. Speaking as a layperson here. Please correct me.

jeffmarc's link is a good one. Please note that as high-risk, you probably want to be using ultrasensitive PSA testing (uPSA). its a more accurate and precise way to measure PSA. As high-risk, it can give you a big potential head start in identifying recurrence and starting treatment. there is a lot of info online, you should do your homework here. For example, some research points to >.03 as a recurrence and >.05 is often looked at as the threshold for treatment initiation for high risk.

I am high risk (cribiform and EPE), currently uPSA testing at .03, will start treatment if and when I go to .05. i test every 2 months. If i waited for a .2 using standard PSA, could be months later before I hit that threshold. I am pretty sure i would be "undetectable" at this point with standard PSA testing. As high risk, hypervigilance and early treatment are key.

lot of good info online an PSA vs. uPSA and adjuvant vs. early salvage. Please do your research.

As always, all decisions should be made with your treatment team.

Grab a cup of coffee or your favorite Old Fashioned, Manhattan, and read this.
https://www.urotoday.com/conference-highlights/sociedad-colombiana-de-urologia-scu-colombia-2025/162647-scu-2025-evaluation-and-management-of-biochemical-recurrence-in-prostate-cancer.html.
What would I do with the clinical data you present.

I would discuss treatment with my medical team: Options may include:

Doublet Therapy - ADT + ARI
Triplet Therapy ADT+ARI+ Chemotherapy
PSMA PET Imaging
Radiation (hint, discuss inclusion of Whole Pelvic Lymph Nodes, not just the prostate bed).

Let the forum know how your discussions go and what your medical team says.

Kevin

I am at .15 and they are recommending radiation both URMC and Sloan Kettering.
I was a Gleason 7 3 4 and had the prostatectomy. My pathology said I had cribform, EPE, and at two locations they could not confirm negative margins due to cautery artifact. While I had Gleason 3 4 the 4 was 30%. What I did not note in the pathology was he called it grade group 3 which is more aggressive.
I went two years less than .02, then I went to .03 then .05 and 6 months later .15 and a .14 test one month later. They recommended radiation and took a decipher test which was .92, very aggressive. You should have them do the test every three months are suggested. You should ask for a decipher test to determine the aggressiveness. While I was a Gleason 7 3 4 which is considered intermidiate the cribform may indicate it is more aggressive.
I am headed towards radiation. As Jeff indicates better results are obtained starting before .2.

@kivanc6081