What should the psa be?

If he's had his prostate removed, the ideal goal would be undetectable PSA, or barring that, to see it continue moving in the right direction (lower at every 3 month blood test).

But depending on his specific situation, just slowing the rise could itself be a big victory. It would be good to talk to your husband's oncologist about what they expect to see and what that would mean for him.

I hope all goes well, and that they take the time to listen and give you helpful answers.

Typically, the goal of being on ADT (Zoladex, Lupron, Eligard, etc.) is to get testosterone levels below 50 ng/dL, and PSA to undetectable. (My Testosterone level dropped to 3.0 ng/dL, and my PSA dropped to < 0.008 ng/mL at one point while on Eligard.)

The fact that your husband is on docetaxel (chemotherapy) means that his situation is not “typical.” So, his goal PSA is whatever his medical team determines it should be for his specific diagnosis. (What is his Testosterone level?)

They didnt make a testesterone test for him

Interesting. While on ADT, it’s important to know testosterone levels.
ADT results in suppressed testosterone, which then starves/weakens prostate cancer cells, resulting in lower PSA.
If ADT no longer results in lower PSA, you’d want to know whether (1) the ADT was not suppressing testosterone levels (thus PSA was not dropping) or (2) testosterone was being suppressed but prostate cancer cells were not responding.
The solution to PSA not dropping low enough would be different in those two cases.

(From the time I decided on radiation treatments and ADT in early 2021, we’ve tested Testosterone level with ADT every time - that’s been 16 tests to date.)

You should ask his doctor why no testosterone tests? He might have a reasonable explanation.

In response to majed's question, what should the PSA count be, John Hopkins Medical School states:
"For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml.
For men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal. The normal range is between 1.0 and 1.5 ng/ml.
An abnormal rise: A PSA score may also be considered abnormal if it rises a certain amount in a single year. For example, if your score rises more than 0.35 ng/ml in a single year, your doctor may recommend further testing."

Thanks for sharing that. Note that the numbers are for someone who still has a working prostate and isn't on hormone therapy. Once your prostate has been removed and/or radiated, the "normal" numbers no longer apply.

From what you describe as his treatment though lacking in his clinical history, has he had surgery, when, what did the pathology report say, if surgery, when was his BCR, has he had PSMA imaging, if so, results, what is his PSADT and PSAV, GS, GG...his PSA should be undetectable early on in the course of this treatment he is on now, say in the first three months, certainly by six.

The old goal was to get T below 50, based on testing capability, newer testing capability has < 20 as objective.

As to his PSA, the objective is "undetectable..." The question is, what does that mean? The answer, it depends..

Found this useful from another forum, what really is “not detectable…?” below the limit of detection using analytical method XYZ" (or simply "below the limit of detection" unless queried further) instead of "undetectable". They typically advised that one could find (or develop) another analytical method having a more sensitive lower limit of detection if there were good enough reason to spend the resources to do so, but it is unlikely that any analytical method would be capable of ascertaining that the sample analyzed does not contain a single molecule of the target substance.

Kevin

Yes. the threshold is important. The standard PSA test can detect down to 0.1 these days, give or take. That's fine for screening, but not for detecting early signs of recurrence (there have been few — *very* few — cases of recurrence near that range). The ultrasensitive PSA (uPSA) test that I get goes down to 0.01, and I have not yet found any mention of recurrence when PSA is undetectable on the uPSA test.

So that's the application of uPSA: treatment has brought your PSA to effectively 0, and you want the earliest available warning of possible recurrence.

Agreed that the uPSA test would have no extra value if your PSA is already detectable on the regular test.

Interesting topic. Back in the day, for a few years after my aPC diagnosis my assumption was "low to no PSA" is good to great. But, that changed. My oncologist, both of them, One my local hospital, the other medical school, are okay with my PSA at 7, for two reasons (1) aging, (2) treatment progressions. I'm on Pluvicto, PSA, gets checked every 6 weeks.

Language, terms and definitions are powerful.

Early in my journey i confused undetectable with no prostate cancer.

I think over time I've adjusted to understand it simply means that it is not that the results mean here are no PCa cells, simply for that equipment and that assay, below the level of reporting, it cannot detect PCa cells which may be present, the infamous "sleeping" ones.

I, and you, know folks who treat very early one using USPSA. That is their choice, and they are comfortable with their approach and decisions doing so.

I have seen the other end of the spectrum, people and their medical team don't pull the trigger until PSA 10 or greater. again, they and their medical team are comfortable with that approach and decision.

Certainly, increasing PSA over several labs using USPA portends recurrence. The questions is, what do you do with the clinical data. As I've said before, my medical team and I use .5 as the trigger, image, then go from there. I'm high risk as you know, GS 8. GG4, 18 months to BCR, rapids PSADT and PSAV, so we treat "early."

Someone with say GG3, a GS 3+4, a PSADT >12 months...may decide to wait longer than I do, and likely they and their medical team are making a good decision.

Kevin