Rising PSA years after radical prostatectomy

I apologize for posting this same question on a related discussion, but just feeling worried and would appreciate any suggestions.

I had prostate surgery in 2015. From that point up until November, 2020 all of my PSA tests came back simply as " < 0.1 '. Then in August, 2021 I think they used a different lab and the result was
"0.00".
I have since moved to a new city, and I just had a PSA test that came back as 0.04. I realize that all of my earlier tests were accurate only to 1 decimal place, but my worry is that if the 0.00 was accurate up to 2 decimal places, then the 0.04 would indicate a jump. I am hoping that the 0.00 is just their way of saying "undetectable" rather than actually being accurate through 2 decimal places.

I would like to know if any of you have had any PSA tests where the lab listed the result as being equal to 0 (I assumed they would have said < .01 instead of saying = .00 )

Not the same as yours, but, I had it happen in reverse. My first test they didn't do an "ultra sensitive" (I think it's called) so it came in as <.2 The following test 3 mos later they did the correct test and it was .039 I've looked through all mine and they go three decimal places but none have zero in the thousandths place, so if mine had been .040 would they have dropped it? don't know.

To answer the specific question, have not had a "0.00". As you read through these posts there are those with a lot more experience than I tell us there's a lot of different equipment out there, and when you get into the low numbers as you are, there are some variables that can effect outcomes.

I'm thinking your trying to compare apples to oranges here. What you're worried about is possible, and it's no fun to have to worry about, but I don't think you'll get a good comparison until you get the next ultra sensitive, or at least the same sensitivity, test. Hopefully it will be the the same or lower. I don't know how often your testing but I'd have another in no more than a couple months just to get a better answer.

Your PSA scores since the surgery have remained very low.
After 4 years its worth getting a Pet PSMA scan which picks up any possible cells that may have cancer.
This is via absorption of isotopes which show up in a different color.
I had the prostate removed in Sept 2018 but the PSA rose rapidly and reached 5.17 recently.
I had a few sessions of radio therapy to treat lymph nodes that showed up on the scans.
Your situation looks excellent but take the Psma pet scan to be at ease

When my psa went from <.1 in 2020, then jumped to .2 in 2021, I was told I had recurrence and I underwent radiation this past Feb-Mar and 6 months Orgyvx. Unfortunately, my psa went to .3 by the time I had my treatment. I believe the Orgyvx brinds psa to undetectable, it did with me. I go back in 5 months for another. I guess that's when I see the result now that I've been off of the adt (Orgyvx).

Not sure if the Orgovyx brings it to undetectable or just helps it. It all seems to be a bit of a crap shoot to me. It may be that the radiation knocks it down and the ADT helps keep it there, and/or (hopefully) starves off the last few stray cells.

My radiation oncologist told me that outcomes are only 3%-5% better with ADT than without. I took it under the "give me all ya got doc" principal. I'm in your shoes as well, but don't really know the docs plan for how long on the orgovyx yet. My guess is that may change depending on how well I'm tolerating it, which is pretty well.

Best of luck to you, hopefully it stays nice and low!

Hi, did you take orgyvx after prostatectomy? Thanks

The short answer is yes, but....
right after surgery I didn't take anything. It was nine mos before my PSA went from .039 to .091, at that point I went on orgovyx and started radiation (SRT) for 40 treatments.

There are some who suggested to me that at those low numbers I may have jumped the gun on treatment and may have been better off waiting another couple months to see what the PSA did during that time period, my urologists are pretty aggressive I guess.

The radiation is over now and I'm down to .014 as of a couple weeks ago, and, still taking the drug. I'm not really certain how long my urologist is going to want me to take it, I tolerate it fairly well. I'll ask on my next follow up.

You may be thinking like I did, why don't they use the ADT as soon as you get diagnosed as an additional therapy and maybe to slow the spread while you make a treatment decision, then after surgery to help starve any cancer cells floating about in the nerves or capillaries? I'm planning on asking that at my next visit just to see what they say, someone here may have already asked that one. Haven't seen if that's the case.

Thank you for your quick response. Still trying to decide on radiation treatment. Don't know if I should have PSMA now or wait until after next result psa in October. What a mess, huh?

It is indeed a mess.
If you insurance covers it, and your dr's think you should have one, I'd probably do it if it were me.
My insurance did not cover it, there are those who would say I may have wasted the cash getting it done as early as I did as the chance of finding something shows a correlation with your PSA. (I didn't know that at the time)
If I recall, under 1.0 is only a 30% chance of positive test. Mine was negative, but, to me, that had value as well, knowing nothing else was lurking out there at that time.

Good Luck!

Hi, why only a few radiation treatments. Imaging didn't find recurrence in prostate bed?