What would you do if PSA stayed at 0.15 after prostatectomy?

@rlpostrp
You can also opt for early salvage radiation. In that case you need to do ultra- sensitive PSA tests, which I would advise anyways due to higher BCR possibility. My husband considered adjuvant but was advised by surgeon and MO not to do it due to possible heighten toxicity so early after surgery. MO advised possibly having 0.05 as actionable number (starting intensive testing and planning RT). RO said that it might make sense to do adjuvant but at that point we did not have the first PSA test done. After ultrasensitive test came at less than 0.014 at 7 weeks post op, adjuvant became really questionable, especially since there are new studies in Japan that show that the first ultrasensitive test has actually prognostic value. Our surgeon confirmed that. The lesser the number, the longer time to possible BRC and better prediction overall.
To make the story short - we made decision to do ultra sensitive PSA tests every month for the first 6 mos and than ultrasensitive every 2 mos. etc. Ultra sensitive test will show possible unfavorable trends "ultra early" and give us a head start. For us PSA of 0.1 will be actually "time to do something" if PSA starts to change early and with doubling time (god forbid).
At the same time, we are just 2 mos post op and only time will tell if the plan is good, but for us it makes sense for now.
Also, our pathology was little bit more "contained" than yours, maybe it made some difference (knock the wood)

Hope I was of any help and I am wishing you a complete success with whatever you decide.

@josephtj I have said before that my PCa history is a series of statistical outliers, and this is true with my PSMA PET scan the past June. After ten years of undetectable PSA (< 0.1) following a RARP in 2015, my PSA rose to 0.11. A DRE also discovered a small (1 cm diameter) nodule in my prostate bed. On the PET scan, the nodule lit up with a SUVmax 0f 13.4, despite my low PSA. Long story short, I am currently undergoing salvage IMRT. My guess is that if a DRE had not detected the nodule, a PET scan would not have been ordered, or insurance might not have authorized such an order based on the 0.5 PSA that seems to be the generally accepted threshold for detection. Saved by the old fashioned finger probe!

@melvinw Thank you so much for giving your experience. Tommorrow I get the PET Scan report and I will be meeting the Urologist in the afternoon. In kerala (India) we can easily get appointment with the specilists without any delay one or two days. And insurance unlike you we have to take our own insurance. In robotic assisted surgery we get only 50% of sum assured.
Once again thanks.

your PSA sounds good but get the radiation to eradicate any cancer cells that got away. It doesn't hurt.

@josephtj Best wishes to you. Glad to share experiences. It fills in many of the things that doctors and staff don’t always cover, or emphasize.

Consulted the doctor. I am told to another 3 months and take a new psa. And watch the trend. If psa is raising we have to do something. Thank you.

@duberdicus Thank you. The urologist asked me to wait another Three months. Then take another psa. If it's coming down, no problem.

@josephtj
Good luck Joseph. Waiting is very stressful and sometimes we just want to do it and get it over, but it is best to follow Dr's instructions and avoid the side effects if it is not needed. Wishing the best for you. David AKA Duberdicus (God of the oceans)

It’s interesting that I had a conversation with my RO after my RP in August. He told me he expected my first PSA test to be zero , I have my first post operative psa test this month and I am hoping to be undetectable. He told me that if my psa is .1 or greater he would recommend considering salvage radiation and if it reached .2 we would already be doing treatment. In my case my margins were negative, the capsule was intact and the only trace of cancer left was at the spot were the seminal gland was connected to the prostate. My urologist has said this had less than a 10% chance of developing so depending on my results on the 18th I could be looking at making a decision on salvage radiation or just active surveillance.

@brucemobile I have read recently while planning for my husband to go back on AS after his almost 5yrs of ADT, and one provider to a PCa patient on ADT told him they'd wait for .5-1.0 and then do an MRI for possible oligo-metastasis and they could spot-treat?