What is the process for a raising psa

[twostrats]

I had an RP in 3/21. Since then I've had 4 undetectable psa results. My question is, when /if it goes up, does my case get immediately turned over to the radiation team, and would there be additional readings/results they would look for to determine next steps? Unfavorable Gleason of 7, T3a. Thanks

[GP24]

Salvage RT should be done when the PSA value rises above 0.2 ng/ml and while it is below 0.5 ng/ml. The results are better if the PSA value is just above 0.2 ng/ml.

[Steve507 in reply to GP24]

I am hesitant to use words like should at 0.2. Were the margins clear? Gleason? Etc

[GP24 in reply to Steve507]

The guidelines state it should be done below 0.5 ng/ml based on this study:

ascopubs.org/doi/10.1200/JC...

The value of 0.2 ng/ml is considered biochemical failure. In the study they included patients with a PSA value above 0.2 ng/ml

Or see Allan's blog:

prostatecancer.news/2016/08...

[Steve507 in reply to GP24]

I've read them all.

I was aggressive in choosing RT at 0.05 post RP due to my positive margins. My of oncologists cleared it for me. Currently 0.004 (yes two zeros) a year later. Quality of life is darn good. I am lucky to have taken it all and not suffering. Still attain wood with and wo viagra. And no PSA testing anxiety

[Justfor_]

PSMA PET scan before sRT as only about 30 to 40% of reccurencies are truely local and within the irradiation field. The rest are distant, mixed local-distant or local but adjacent to organs to spare. The PET scan, although not 100% conclusive at low PSA, can enhance confidence regarding locality, thus decrease the probability for a sRT failure.

[LowT]

I believe your path report indicated some bladder neck involvement. Why not get an ultra PSA?

[twostrats in reply to LowT]

My surgeon said he addressed the bladder neck invasion during the surgery. From posts I've seen on here it seems like the ultra psa's tend to create a lot of anxiety when the next step wouldn't be until 0.2ish anyway isn't that correct? I'm not great at picking all this info from here up so maybe I'm wrong. It's been a little over a year since I was diagnosed and I've picked up a lot, but still learning.

[LowT in reply to twostrats]

Only you can decide that. Each PCa case is unique. And the PCa is occurring in a unique individual. Personally I want as much information as I can get before making decisions. Of course within reason. Seeing the “picture” as clearly as possible before “placing my bet” and then living with the outcome knowing that in the end I’m not in control, and being comfortable in doing what I consider my due diligence. If one is prone to anxiety that is part of the context. Only you should decide along with your doctor. Good luck and keep us updated.

[Magnus1964]

Radiation would be an option.

[LowT]

Ignore my earlier comments. I didn’t realize your PSA was as high as it is. No need for ultra PSA

[Tall_Allen]

It depends on a lot of factors. For now, you have get results.

[LowT]

My bad. I looked at wrong PSA value. My original comments stand. Sorry for confusion

[MateoBeach]

You are still in the group of those likely cured by primary treatment. Yes, it is stressful but you seem golden. Congrats!

[Steve507]

By undectable, do you mean less than 0.01? or 0.1?

[twostrats in reply to Steve507]

<0.1

[Steve507 in reply to twostrats]

Great

[Steve507]

In 2007, Radiation treatments were crude compared to today. I have no side effects worth noting after both RP, ADT, and SRT, other than some sweating and BP rise after that damn ADT. I agree that a strict natural regiment of diet and exercise can be curative, but the reality for me is simply this: I enjoy my brew and beef. Important to my quality of life. I admire those who can go the other way. Prostate disease is very idiosyncratic and my best advice is to be proactive and get to know your body, I.e... your disease.

God Bless all of Us