When does rising PSA require further treatment.

[Coupe31]

2010 robotic prostatectomy at City of Hope, 2018 IMRT 3 months ADT at Johns Hopkins. Last 6 PSA tests at 6 month intervals: .03, .04, .04, .05, .02 and last .05. If PSA continues to rise, when is further treatment recommended?

[GP24]

There is no definitive PSA value which should trigger additional treatment. I would recommend about 2.0 or 3.0 ng/ml. The value of 0.2, which triggered the IMRT radiation, does no longer apply.

[Magnus1964]

Your PSA may shows there might be some activity. You might have some scans done at this time even though the rises are small.

[Hidden]

Do you think that there is a meaningful difference between. 03 and .05? I don't...if it rises to .08...then I would begin to look into it.

[MateoBeach]

We certainly understand your worry that the PC may not be completely gone. But you are in a situation that everyone on this site would like to be. There is no scan in existence that could show a cancer site at such low PSA levels in non advanced disease. I don’t see your current age or Gleason score. But your PSA doubling time appears to be longer than two years. Unless that Changes you would not even need a scan for 4-5 years when it reaches at least .20. Who knows what other treatments might be available by then. Today then next step for BCR would be radiation treatment (SRT) to the prostate bed and pelvic lymph nodes. You could consult with a good radiation oncologist if you want to be on top of it or are inclined to be very aggressive. But they may advise you that the risks may outweigh the benefits at this juncture. Yet if you are young it might be an opportunity to salvage a cure.In any event, you should do what you can to prevent any remaining PC from progressing to more advanced stages. This is approached by two means: minimizing inflammation in your body, and protecting against genome damage (accumulating DNA mutations). Those are the drivers of cancer progression known as “The Hallmarks of Cancer”. See a previous post of mine of this topic on this site. 🙏👍

[Tall_Allen]

It depends on absolute PSA, PSA doubling time, symptoms, and imaging, and your comfort with doing nothing. Some start intermittent, light ADT at a PSA as low as 0.2; some wait until 2.0; some go heavily with hormone therapy (on a clinical trial). This is something you should discuss with your MO.

[Fairway]

Not knowledgeable this area, but wishing you the best!