PSA Post RP

His PSA dropped really nicely (knock the wood) and as far as I know most doctors will consider that undetectable and as no reason for further treatment at this point. However, if your partner's cancer is highly aggressive, it is very wise to have MO consultations and it is excellent plan. My husband also has very aggressive cancer and our MO suggested that perhaps we should start thinking about early salvage when and if his PSA reaches 0.05 and than have radiation therapy at 0.1. Since your partner's first ( the very first we do not count because it was just a "trend test") PSA is 0.07 they might want to wait for the next one to see if there is any movement upward at all. You see, it all so individual and depends of so many factors that it is impossible to predict "when" the next treatment will be. The only thing that is for sure is that it will happen if his PSA ever comes to 0.2 (or 0.1 if you decide to do early salvage therapy ) and it will be radiation with probably short ADT . If you have good doctors try to relax now somewhat, I know that it is very hard < 3, I am working on that still. Just stay on top of the things and results, visits and doctors, all the rest is out of our control. His PSA might stay stable at 0.07 for many years too : )))) ! One never knows < 3
Wishing you the best of luck with the next PSA test and super successful consultations with your MO

PS: Since I want to be extra diligent, I make my husband take PSA test every month - it gives me a peace of mind

It is difficult to provide a helpful response with the limited amount of information in this post. Perhaps you provided in an earlier post. Typically the information. Would include age, Gleason score, Decipher score, post surgery pathology results, any hormone treatments prior to or post surgery. It. Is also helpful to know where he is being treated, as many on this forum have experience with most Prostate Cancer centers.

However, assuming the surgery was in late October and the Gleason Score was >7, it would be more typical today for the first post surgery PSA at the 6-8 week point and the next PSA at the 12 week post surgery point so that the PSA trend is established. Using this data, his MO could then advise if any next steps, including next test.

I have the impression that the docs use the trend up vs. down to make decisions. It’s hard for us to wait between PSA tests but we have to wait. My husband had his first PSA post prostatectomy at 6 weeks and another at 12 weeks. Unfortunately the trend was up but that trend determined the start of ADT and required our insurance to pay for another PSMA pet scan. With the numbers you have the lack of urgency for more treatment is understandable, at least to me.

Someone in this group just yesterday responded to a similar question and provided this recent paper on the reasoning for adjuvant vs. early salvage vs salvage once PSA is above BCR (>0.2 ng/mL). It really boils down to the overall health and age of the individual couple with an assessment of the overall risk of recurrence and metastasis for the individual. I am one of those people in the “very early salvage” group - rALP was 9/22/25. I’m Stage pT3b, R1; GS=4+3; 4 positive margins including both seminal vesicles and bladder neck, Intraductal Carcinoma, Cribriform, Perineural Invasion, Decipher Score of 0.89 (very high).
This study and a few others have helped me to cement my plan - my first post op PSA was 0.03 ng/mL taken 10/29/25. I have my next blood draw for test Monday 12/12/25. If it has gone up more than 0.03 ng/mL (doubled or more), I will retest in a couple weeks to confirm results and if confirmed I will be pursuing salvage treatment which will most likely be ADT and radiation.

The article is in Urology Today from a APCCC conference in 2024 titled “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”

@surftohealth88 thank you for reaching out. I think I’d like to have him do PSA monthly too. I’m just too nervous to wait 3 months. Is that unrealistic or unreasonable to ask?

@esperling I think this is most likely the treatment that my partner will also have. I’ve read a bit and it seems like the likely outcome.

I guess we’re just waiting for the PSA to do its thing. Let’s pray it doesn’t want to do its thing 🙏.

@sriddle1 exactly and yes let’s pray that our cancers both remain too weak to reawaken forevermore.

@sriddle1

We go to WalkInLab website and order ultra sensitive PSA test ourselves and than he goes to local lab and do it. We find it really convenient and I prefer not asking doctors since I am sure that they will say that there is no need for that. There is a difference between of what they need for their decision making and what we need for ours ; ). So far doctors were always late with every step taken and I now try to be ahead of them as much as possible and plan ahead - same as you are trying to do and IMHO that is the only way that we do not "miss" something yet again.

I guess we shouldn't be surprised that surgeons are more worried about doing a good surgery than about how clearly we understand what's coming next. At 2 months post surgery you may still not be at a baseline? You are looking for that nadir (low point) while also measuring very tiny amounts, leading to random fluctuations as well in what you're measuring. It would definitely be nice if it keeps going down.
The goal, of course, is to be neither early nor late, since the treatment goals are not cures, but rather delays in progression. In other words, rather than putting the fire out once and for all, you're looking at the advancing enemy and deciding when to fire your limited supply of ammunition.
Perhaps fortunately, the advancing enemy is moving in months and years rather than days and weeks.
So the first task after surgery is recovering function and enjoying the present. If tracking an elusive PSA makes you happier, why not? I don't think monthly blood tests are particularly deadly, just "medically unnecessary." But any MD should be happy to look at more data, even if they just say, well, that doesn't really change anything. After all, they spend most of the day every day at work looking a data (except, depending on how you define data, maybe doing surgery?!)
BTW, remember that different labs use different assays (recipes for analysis) so results aren't directly comparable although they should be close since they are attempting to measure the same thing, so if you are going to one lab that the MD orders and another in between, you really have two different series of results to compare--the trend lines should be the comparable, but not necessarily the numbers.