First PSA after RARP

[Pca2024]

My dad had RARP on Jan 19,2024. Gleason 8(4+4) PSA 12, clean PSMA pet scan before surgery. Path report had no LN SVI or EPE but PNI and 50 percent prostate involvement. PSA today 6 weeks post surgery came out to .09. What should we do next? Age 73. Tall_Allen Please advice. Thanks a lot for your help warriors.

[NanoMRI]

Eight years ago this month, 58 YO, otherwise excellent health and fitness, my usPSA post RP was 0.050. We accepted cancer remained. For my next step I began monthly testing and set 0.10 for my next treatment stage - note this value is (still) below common guideline of 0.2 for CR. Using three-day PSA half-life calculation perhaps your dad's will come down a bit more, and of course repeatability is important. There are several options for next treatment. I chose salvage RT, no ADT, without imaging. Today, I would seek both PSMA and choline imaging before making my next treatment decision. My salvage RT did not get all the remaining cancer as it had spread further at 0.1 than anticipated. All the best!

[Pca2024 in reply to NanoMRI]

Thanks. May I know how long after RP did you get tested for PSA ? Secondly is Nano MRI better than a PSMA Pet Scan and where to get a Nano MRI ?

[NanoMRI in reply to Pca2024]

My first test post RP was four weeks. My pre-RP PSA was 10 and we went with two-day half-life calc. (I was anxious and had settled on <0.010 as best indicator). Of course verified with next test, four weeks later, which was an uptick. As for 'better/best' imaging, Dr Kwon of Mayo has a YouTube video on this discussion, suggesting not to rank but rather using multiple imaging contrast agents may be the best investigative route. Note, the nanoMRI is not referenced in his discussion. In 2018, post salvage RT, with usPSA back up to 0.11, I went to Europe for Ga68 PSMA (could not get into a 'trial' in US), combined with thought to be 'better' Ferrotran NanoMRI. While the Ga68 was clear the nanoMRI indeed identified suspicious pelvic lymph nodes - which were confirmed by extended salvage lymph node surgery (note this procedure is rarely done in US).

[Justfor_]

One of the side benefits of RARP is that one gets an early enough good estimate of the disease aggressiveness. Most silly docs will advise your father to take PSA tests quarterly. Silliness unlimited. Have him go for monthly PSA tests, so in 6 months he will have a time series of 5-6 PSA samples after which a no-nonsense PSADT (doubling time) can be derived. This will be his only solid guidance metric. Everything else is merely opinions, opinions, opinions...

[NanoMRI in reply to Justfor_]

I concur with your 'silliness' characterization. I know many a men who chose RP, first test within 4-5 weeks; I am one, and am glad I tested soon and often. Many of us find monthly testing very valuable in the first year after treatment. For me, instead of relying on doubling time, I set a value for action. Post my RP nadir of 0.05, I set 0.1 for actionable value. I relied on this again post my salvage RT. Today, given that I had serious pelvic mets confirmed at 0.10, 0.03 is my first actionable value, imaging (yes, well ahead of guidelines) and blood biopsy are my first actionable. If/when my PSA moves into 0.05X range I will look to next treatment. My focus for past ten years since diagnosis has been and remains to delay ADT/chemod/CR for as long as possible.

[Justfor_ in reply to NanoMRI]

I am almost 5 years post RP and continue monthly PSA tests. It brings me peace of mind.

[Don717 in reply to Justfor_]

I'm with ya. Weird, my change of heart...I hoped I would remain <.02 for 2 years and get moved to 6 month testing. Got my wish and now I long for the 3 month tests! Coming up on my first 6 month jaunt mid April and I'm going back to 3 month after that. Maybe back to 6 months after 5 years? See how it goes. I actually find it's not an anxiety issue but more of a loss of control.

[Tall_Allen]

Your PSA test should not be done for 3 months after your RP.

[Pca2024 in reply to Tall_Allen]

Thanks for responding. We would repeat once three months have passed since surgery.

[Pca2024 in reply to Pca2024]

Tall_Allen at 3 months it came out at 0.1

[ron_bucher]

PSA trajectory is more important than any single reading. Monthly PSA readings should inform treatment decisions.