PSA rising with 3.3month doubling time after Radical Prostatectomy. Further actions?

[FiguringOut]

Patient age 60.

DaVinci Radical Prostatectomy was done in October 2021. Gleason 4+3. The cancer was contained in the prostate, it had not spread at the time.

After the surgery the PSA has risen:

24.11.21 0.009 ng/mL

17.03.22 0.027 ng/mL

31.05.22 0.032 ng/mL

What is the best route of action that should be taken now?

What scans, PSMA/PET or something else, what radiation (would Cyberknife be ok in this case), hormones or no hormones?

Problem is the urologist for the person is not available until August. We are trying to find a different urologist, but I would like to know general opinion of those on internet also.

Thank you for any advice.

[Justfor_]

Monthly PSA. To get a somewhat reliable PSADT you will need at least 5-6 time samples. Do nothing but monitor bellow 0.06. PSMA at 0.1 provided that the 3 months, or about, DT proves correct.

[GP24]

This are very low PSA values. No immediate action is required or would be helpful.

[Tall_Allen]

You are jumping the gun.

Both of your last 2 PSAs have been 0.03, which is minimal. PSAs every 3 months may prevent your overreaction to random fluctuations. You have plenty of time to decide after your PSA reaches 0.1

Doubling time is not validated for values below 0.1.

[MateoBeach]

Well at least enjoy the time this coming year without treatment. If and when you might reach the 0.1 or 0.2 threshold for BCR then the course of action will best be extended field Salvage Radiation Treatment, including full pelvic fields and accompanied by at least short term adjuvant ADT. Just keep that in mind and maybe get consults with radiation oncologist at your institute of choice to establish a relationship. No hurry on that though.The most modern IMRT / EBRT linac systems are so excellent and precise now. I am suspicious of Cyberknife and similar, with deceptive names for radiation delivery. Not convinced that they are actually as good for targeting fields rather than discrete tumors. Have heard of so many failures. Perhaps just my bias. But those with those systems sure like to sell them.

Many here use adjunctive supplements, plant derived nutraceuticals and pharmaceuticals to hopefully make one less vulnerable to cancer progression (not cure). Others here are vehemently against supplements not proven in clinical trials. Your choice. You can find much discussion of these on this site. Choose wisely and don’t get confused or go down any of the many rabbit holes if you do explore that. Plant derived polyphenols and flavonoids are safe territory IMO. Reduce inflammation and protect your genes from mutations are the drivers of cancer progression.

Welcome and wishing you long healthy life. Paul

[MateoBeach in reply to MateoBeach]

Oh, and also your Urologist won’t have anything to offer if you do end up being BCR and need further treatment. Only if you have a surgical complication. Future care and treatments will be with an RO and MO as your team.

[j-o-h-n]

One step at a time.........

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 06/15/2022 7:01 PM DST