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PSMA PET scan: then what?
I had a prostatectomy in July 2022. The pathology report showed clean margins and no spread to 12 sampled lymph nodes. PSA tests were < 0.1 for two years, but over the last year they have risen to 0.2 and 0.21 in June and Sept of this year, respectively. I have a PSMA PET scan and MRI scheduled for the end of Nov. What comes next if the scans find something? What if the scan don't find anything?
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You are in a real gray area. 3 1/2 years after my prostatectomy, my PSA started rising and hit .2. They immediately set me up for salvage radiation. There is a reason for having to do it at that point and your waiting may not be a good idea. Here is what ASCO says about it, they discuss prostate cancer standards.
From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL: Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%). Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL: Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL: Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.
This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/
I had same situation after two years from RP , PSA rised to 0.2. Salvage radiaton with 6months orgovyx and 33xRT. No visible tumors on PSMA-scan. First PSA after that was under 0.1. Second test is in two months. I cant even think possibility that PSA has risen again...