I believe the typical recommendation is after the initial definitive treatment (surgery or radiation) to do PSA tests every 3 months for 2 years, then every 6 months for 3 more years, then every year (in the absence of a recurrence.)
I'm curious what people's histories have been at various stages of their journey after initial recurrence regarding frequency of PSA testing. How frequent, when did you change frequency and why? How much of the decision was based on your own personal opinion versus just following whatever your doctor asked you to do? Looking back do you feel there were periods you could may have benefitted from more frequent testing or periods of less frequent testing because you think it didn't provide much benefit in your treatment decisions at that frequency and only caused increased inconvenience and pre-result anxiety?
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jazj
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I do them every couple weeks when I'm actively lowering PSA. I get em under $30 at ultalabtests.com because I do t want my Docs interacting until they have to. You can also do tumor marker tests as I do.
I've never heard of that high a frequency (not to say it isn't used). I'm curious what you are doing to "actively lower" your PSA. Are you doing that frequency to experiment with trying different naturopathic treatments?
I mix the natural stuff with.medicine intermittently and have so for over 12 years. It keeps me from getting resistant and preserves my quality of life and keeps my Docs happy. They always are amazed.
TCM has numerous studies on its efficacy for Prostate, Colon, and Breast. For me it has kept me alive with intermittent ADT every few months as directed from my ONco in Canada. She saved me.
The public healthcare system here is ok with one every 3 months. For the rest I pay out of pocket at 14 Euros. The actual frequency varies according to my algorithm for Bicalutamide adjustment from min 10 days to max 45 days. Anxiety, what is this? I have 3+ years of data, so I can take my pre-result estimates to the bank.
I have Isup 5 ,gleason9 agressive metastatic pca. Diagnosed august 2023. Psa was2500. Widely bone metastases and metastases in lymf nodes . Lots of pain then. StartedFirmagon and all pain was gone in few days(!) Had chemos(6x docetaxel) .last injections29.2.2023. StartedNubeqa in january 2024. Psa was taken when last chemo february 2025. Next psa in august 2024. Now going psa test in february 2025. So I think in my case psa every6 months. if not new pains..
Stage 4, Gleason 9 diagnosed almost exactly a year ago in Jan 2024. On 3-monthly leuprorelin shots, daily darolutamide, completed 6 cycles of docetaxel in July and have remained pretty much undetectable since then. PSA tests together with oncologist consultation have been monthly for the last 6 months, but after I finish consolidation radiotherapy (20 fractions per STAMPEDE protocol) at the end of this month we’re moving to no-monthly. Triggers for cadence adjustment will be a rise in PSA and/scan results (which I’ll probably have in May-ish to allow things to settle after radiotherapy).
5 yrs post 39 EBRT. G4/5 now 6 monthly PSA testing.. PSA very slowly rising. Travel frequently so decided 6 monthly testing with Oncologist agreement. Will consider further options if necessary.
here is an earlier discussion on why I think using the ultra low PSA assay (test) is advantageous. Or u can just use the standard test. U decide which is best. (Hope this works). Rick
An excellent shared discussion IMHumbleO. I have been holding 0.03X range over three years now, no ADT. I decided on uPSA and <0.010 as best indicator nine years ago.
RMontana has shared a perspective on this within this tread.
Note this is a post RP discussion.
Now some members may jump in here and scold me for my choice: one member (who wonderfully has not faced metastasis) strongly states ultrasensitive PSA testing should be done away with and another has poopooed my European medical 'colleagues' who also support my decision.
I say I "decided" because we face disparities on this topic. Many it seems continue to rely on 0.20 for recognition/declaration of BCR post RP - cancer. Some now rely on 0.10.
Yes, I rely on <0.010 (not 0.1) post RP and lower as best indicator. I would never say this means no cancer and as mine got out and as far as para-aoritc I do not think in terms of being cured.
As my salvage ePLND confirmed six cancerous pelvic lymph nodes at 0.13, I have no doubt cancer is present and active below 0.1. (some chastise me for this anecdotal treatment decision).
At <0.010 and lower my only action is frequent uPSA testing to stay well ahead of initial signs of recurrence. As I share I do imaging and liquid blood biopsy testing at 0.03X, where I have been hanging out for past three plus years. (caution - firm scoldings by some members get handed out for this).
I hope this clarifies my decision.
Side bar, responding from infusion/phlebotomy lab where I am draining a pint - do this to lower ferritin as higher range ferritin is associated with PCa - in some opinions. I also now do this for second reason - hemochromatosis.
Fascinating. I recall seeing at least 2 studies that showed psa rises in ranges < 0.02 were highly probably of recurrence. But it appears the amount of data has coalesced at the 0.03 level. I am very skeptical of any doctor or care center that is still referencing 0.2 as the level to confirm biochemical recurrence and not re-labeled it as the level for actionable salvage therapy and replaced it with 0.03 as the level for biochemical recurrence. I know of no doctor at any center of excellence that is still saying BCR is only confirmed at 0.2. Just that they don't recommend doing anything until that level.
In my opinion this is the biggest misunderstanding of the average PCa patient due to most of the literature existing involves studies performed when 0.2 was still used as BCR indication and thereby most patients don't realize a lower level has been determined to be a reliable BCR indicator post surgery. I think one could argue 0.04 or 0.05 as more "iron clad" but in my estimation anyone saying they are "stuck at 0.03x" (absent active systemic therapy) has not been stuck at that level for 15+ years. More like 1-4 years is my guess.
Very good discussion! (I appreciate the absence of the naysayers, so far anyways).
My RP nadir was 0.051. My doc and I accepted cancer remained. What to do and when? I tested every month to thousands and tracked rise to 0.11 over next ten months.
Eleven months after my RP, at 0.12, I did salvage RT to prostate bed, shooting blind; 2016 U.S. available imaging was not considered "sensitive enough". Post SRTPB nadir 0.075 - we missed. Had I acted sooner would we have gotten it all?
As I share, after my salvage ePLND I had cancer confirmed at the para-aortic lymph nodes. That was twenty-six months after my RP. When did cancer get there? Was it there at the time of my RP then stayed put? The questions we cannot answer.
Referring to your bio - "(Consult with Dr. Amar Kishan at UCLA who believes Salvage RT is not necessary when I reach 0.05 but if I want to do it earlier than later 0.1 would not be premature. Dr. Lin at UW/Fred Hutch says they don't recommend salvage treatment until 0.2)."
Can Dr. Kishan or Dr. Lin today or after further rising PSA to a chosen value assure you your cancer has not spread beyond the next treatment field, whether it be prostate bed or pelvic region? I have seen no trials nor "highest levels of evidence" that this can be accurately determined by PSA or any other method.
It is logical to me the more time we give cancer to grow and spread the thouger the fight. If ADT is planned to be part of the next treatment perhaps it does not matter so much if one waits for a higher PSA value, perhaps until PSMA or other imaging finds some of the mets.
I share my intent since my RP nine years ago has been, if it comes to it, to defer ADT/CR as long as possible. I have been very low stable 0.03X range since June 2021 (month testing records), no systemic therapy. That's three years seven months. My last uPSA was 11 December, 2024, actually down a bit to 0.029. To your point of being 'stuck', wouldn't it be great to be stuck (absent active systemic therapy) here until I die from something else (like most men with PC)? Of course it would be great at 15+ years. Would suck if next week.
We think alike. That's why even though I'm not at an Advanced stage, the information about treatment histories shared in this forum are so valuable. There's a lot of smart people here with a lot of experience fighting this disease.
I've said it in one way or another and I'll say it again, the risk with this disease is not knowing what you don't know is there. In general it seems cancer does not recur in the specific areas receiving the full planned dose of radiation. It pops up later somewhere else. The most common outside the prostate bed is the pelvic lymph nodes. So in my mind the major decision in having salvage RT is do you only also include the lymph nodes in addition to the prostate bed or the whole pelvic area to try to incude more potentital micrometstatic disease in the radiation field? The latter typically comes at a cost of more side effects but who wouldn't trade moderately worse side effects for higher potential of being cured?
There's always this talk about "overtreatment." The problem is, if you undertreat because you're only treating (via radiation) the prostate bed and anything outside it you can confirm on imaging, and you have a second recurrence, then the cure ship has sailed and you are moving on to a game of delay.
I think part of the issue is the physicians don't want to go along with a treatment that technically might be considered overtreatment under the SOC, then the patient is very angry in hindsight that they went through all those more pronounced side effects and still were not cured. Sure seems like a moderate increase in risk of grade 2 late toxicity from expanded RT is a good trade off for a higher chance of never having to do those systemic therapies with nasty side effects for the rest of your life.
When my prostate was removed a bilateral lymphectomy was also performed which probably curtailed further metastasis.
Months later there were additional lymph nodes that were avid and these were addressed with the Radiation Therapy which went beyond “salvage”… more of a consolidation radiation. Which included the prostate bed/pelvic fossa and the left para aortic lymph node.
My dream data experiment would be for Quest (threshold <0.02) or Labcorp (threshold <0.006) to have to dump all of their uPSA test data for all patients with sufficiently long, regularly spaced uPSA histories and run stats based on that and see how many eventually got over 0.2 and what the trends are. There's a goldmine of info there.
When I see people on these forums post that their first uPSA after surgery is 0.025 and they are happy about it because it dropped from 20 pre-surgery, I really want to caution them strongly. I do my best to not get Dunning-Kruger-ed to death, but the data in the several studies I've seen are pretty clear that the odds are strongly against you in those situations, in terms of eventual further treatment. Still good odds in ultimate outcomes after salvage RT...but folks (and the docs) know where they are headed more than the docs are letting on.
There are several studies in recent years examining post surgery outcomes at PSA levels 0.03 and none of them found the patients didn't progress what hit 0.03. The UCLA one is references a lot (just 247 patients but no studies have disproved their conclusion.) auajournals.org/doi/10.1016... ("Ultrasensitive prostate specific antigen 0.03 ng/ml or greater is an independent factor that identifies biochemical relapse more accurately than any traditional risk factors and confers a significant lead time advantage.")
I took a peek at the Reddit forum on Prostate Cancer and OH BOY, there's unfortunately a lot of people there in for a rude awakening down the road.
My dream experiment is take a couple thousand patients post surgery with similar pathology and their nadir 3 months after was < 0.02 but then went above 0.03. Include some biomarker segmentation in there like Decipher scores, Artera AI, etc. Do salvage RT on some at 0.05 some 0.1 and some at 0.2 and see what the 5, 10, and 15 year outcomes are.
uPSA gets me excited! There isn’t another more precise standard cancer test out there in really any cancer. We are lucky to have it.
I’ve read that Kang study you referenced. I have also seen a 3yr recurrence nomogram in a Chinese study where initial post surgery uPSA was found to be a very strong predictor. Basicallly, it started counting against you once you got to 0.01 or more in that particular study, with >0.02 even worse and above 0.05 really bad. You can see it here:
And, I like your study idea, although I think the <0.02 might be not be a sensitive enough test to use. In that Chinese study above, they define 0.2 as BCR. They are only focused on the first 3 years. If you started out at 0.002, let’s say, and had a doubling time of six months, you still won’t meet their criteria of two tests of 0.2 before three years. I really believe that lower is better if you really want to know what’s going on and how far away the train is. Having said that, I completely understand why others don’t want a test more sensitive than 0.1.
Time to walk the dog. She doesn’t care about any of this!
The doc’s I consult with write orders for the maximum reimbursable frequency. Then I self-direct/self-pay through RequestATest or WalkInLabs.
Looking back to my salvage lymph node surgery seven years ago, I could have stopped testing after multiple confirmed nadir results of <0.010. This is because my uPSA has not (yet) risen above 0.03X range and I have taken no further treatment actions. (think of the monies, time and mileage I could have saved).
As for inconvenience I do not find focusing on my health and being pro-active inconvenient. As for pre-result anxiety, testing on my frequency resolves my anxieties.
In addition to my (very) frequent uPSA testing, I have annual-ish imaging and liquid blood biopsy testing. This investigative trifecta (active surveillance) for possible/likely remaining cancer (in some cellular form) assures me my broader treatment path has been good for me and that I still have no need for further treatment nor to make changes.
I agree with you that frequent testing tends to relieve my anxiety. I would rather know if PSA increasing so I can be proactive in treatment as needed.
I like your counterpoint that more frequent = less anxiety. Strangely I haven't thought that way. I guess I was just referring more to short-term anxiety in the few days leading up to the blood draw and the day or two waiting for the results (actually I get my results almost always same day.) Dealing with the fact no one will ever know for sure you are cured for life probably always carries a degree of baseline anxiety with most human beings. (But that's also the same as worrying about all the other things that might kill you that you don't know you may have or get.)
Longer term, my feeling is based on my own PSA kinetics the first 2.5 years of 3-4 month frequency, I don't think I will miss any critical treatment decision points at 4 months or even 6.
I've personally found the opposite though as far as treatment frequency regarding everyday background anxiety. Despite being very active on this board, since my PSA started very slowly rising, the longer the time between tests the less the disease is in my mind, the less worry I have on a day-to-day basis. Personally if my PSA is going to rise 0.1 in a 1 year period, if I had a choice between seeing 4 small increases versus 2 larger ones with half the testing frequency, I'd opt for the 2 larger, less frequent test results. Personal preference based on how my own mind works I guess.
Looks like 3-months is turning out to be the most common at most stages except maybe more frequent when changing drugs, or less frequent if PSA has not moved up for several years.
Well, 11 years into this and I never reached the six month or annual phase, it's pretty much been every two to four months. With high risk PCa, I am not comfortable with testing at any interval outside that range.
I’m stage 4 pT3b n1 m0 . I just finished 3 years of treatment and will continue to do an ultra sensitive test every 3 months till 5 year mark… personal preference.
On Lupron/Abitaterone/Prednisone, since Oct 23. I had Pelvic IMRT radiation and then some SBRT for lymph nodes in the periaortic region starting at about the same time. . Since then I have PSA done quarterly. It has been <.004 at every check. (One coming up next week, blood drawn on Thursday).
At this point it is what the Oncologist wants, and I trust the Oncologist team.
I've always been surprised that clinics even offer a third decimal precision result. I've seen any data to indicate there's some reliability in BCR indication at very low levels, but they aren't used because there's also a high chance your third decimal can bounce around all over the place without the second decimal going up. I've seen posts by people agonizing over a rise in the third decimal with no change in the second only to see that third decimal go down on their next result.
I guess just like I lean towards preferring a bit less frequent tests, some people lean to wanting more precision, or maybe it's not even up to them, it's whatever the clinic that you use provides. If I were the clinic, even if the test went to 3 decimals, I'd chop off the 3rd decimal on the result.
My apologies I added an extra zero. The correct number is<.04.
I have asked the clinic about resolution and they have told me any thing below is virtually undetectable. The MO has also said they will not be concerned unless it is 1.0, any number above .04 would be notable as is has been that for some time. If it did start raising, a next month after test would become prudent to see if a trend is starting.
The blood will be drawn for my 3 month testing, next week.
What cutoff does your clinic consider less than that being undetectable? 0.01? 0.02? 0.03? I think it's most commonly either 0.02 or 0.03 for most clinics in the US here.
Interesting how some are 0.02, some 0.03, some 0.01. Anything that is 0 to two decimals, seems like the logical definition of 'undetectable' I guess that's why my tests said < 0.02 and not "undetectable" It seems to me 0.01 is more of a choice by a lab that is concerned more with accuracy than with perception of what it means to the patient. To have "undetectable", versus 0.01 versus a < 0.02 result can be taken differently by the patient. When in reality there is probably always some minute amount of PSA (0.005 for example)
Whatever the number, it is undetectable on the machines the lab uses. <0.04 means that's as low as the lab tests. If PSA is 0.03 that lab can't detect it.
Seems I am the outsider in regards to PSA testing after radiation and ADT treatment. I am almost 15 months post treatment. My MO and RO only wanted to see me once a year now. I suspect that they were confident enough to do that based on their analysis of my prior treatment.
I scheduled those visits so between my GP, MO, and RO I get a PSA test every about every 4 to 5 months. Consequently although they only see yearly results I get to self monitor my PSA. That works for me.
I am confident in my ability to see a trend in PSA. I can call for an appointment with my MO to discuss any changes that concern me and I can always pay out of pocket for a test if I want to increase PSA testing.
I am not one who believes in either over reaction to this cancer nor over treatment. That may not work for others.
Right now I have no scans scheduled. I have not seen my urologist after diagnosis and staging. My MO, GP and RO have been monitoring my case since radiation.
PSA has been very low during and after ADT ended. Even when T returned. I guess I am one of the lucky ones so far.
Not sure there is anything I really need to do additionally at this point except enjoy life.
If you get your tests at the same place as your Urologist or Oncologist works at (like me), they get notified of the test results so I'm sure they would contact you if based on your latest test result they think you need to have a conversation sooner. For those doing their lab work elsewhere, can't you pre-authorize the results to be sent to your doctor? Or in most cases if the patient does the lab work outside the facility network of where they are being treated, they have to be proactive to share the results themselves?
I didn't change anything, I went with the suggestion of the oncologist. I believe for 4+ years I have had PSA checked every 3 months approximately. Scans went from 3 to 6 to 12 months apart.
This brings up an interesting question. Are infrequent scans at low PSA levels (say < 0.5 after surgery or < 0.5 rise after RT nadir) prior to any secondary/salvage treatment useful or even covered by private insurance? I've seen claims that some PCa does not produce PSA. Seems if you are trying to surveil you status as accurately as possible, even though the sensitivity of the scan is low, if insurance covers it, maybe a scan every couple of years is prudent? Or are you just unnecessarily exposing yourself to more and more positron emissions and radiotracers?
jazj, when I fist started ADT (Orgovyx) in Feb/2024, my blood tests checking for PSA (16.6 max) plus other items were taken every 3 months. After my RT to prostate and local lymph nodes in Sep/2024, abiraterone/pred was added to my ADT regimen and my MO requested monthly blood tests to check PSA and other parameters, starting in Oct/2024. My next appointment with my MO is in Feb. If everything looks good, I would expect him to back off the frequency of blood tests. My PSA remains undetectable since finishing RT. BTW, that was the case just before starting abiraterone.
This sort of confirms my suspicions of what is most commonly standard practice. After initial treatment you do semi-high frequency (3 months) to gauge the effectiveness of the treatment and in the absence of PSA rise with fairly short doubling time, you might go less frequent. At a more advanced stage, logic would dictate a very frequent testing would be informative on whether or not a drug change is making a difference.
Husband Gleason 8. Bone mets appeared a year ago (PSA had been rising before that but the scan the year earlier did not show any mets). On doublet therapy once Mets appeared (had been on mono bicalutimide therapy the year before that but achieved only a temporary halt to PSA before it started rising again) and gets annual PSMA and bone scans. Blood tests quarterly.
I am GS 3+4=7...PSA was up to 19.3 in July,2021 when i finally stopped AS and had SBRT treatment without ADT. I was 81 at the time. Since then I have had PSA every 6 month starting with post treatment score of 5.0 and gradually coming down to current .27 as of last week. I am going to a new RO this month who is much closer to where i live. Looking forward to her evaluation of my case going forward. I have several serious co-morbidities so at this point I am hoping to fit in the category of dying with, not from, PCa. That said I will continue to be tested and followed closely. Im not sure my PSA will or can ever reach 0, probably due to my refusal of ADT. Will always be grateful for this website!.
As we all know, PSA testing can help determine prostate cancer at an early stage. As men age, the likelihood of contracting prostate cancer becomes greater. We know that as well. The old stodgy school of medicine believes it better to withhold PSA results or not give these tests to older men patients. The more enlightened school believes it is critical to older men's health to give this PSA test several time a year to detect the onset of prostate cancer; GPs who minimize providing this information or fail to give PSA tests to their older men patients might consider changing their profession --Undertaker might be one--or retirement. The rationales given by the "establishment" for not providing PSAs borders on idiotic--a shade before criminal. Give us us older the respect they deserve
Agree. It's an epidemiological numbers game. Stop PSA screening after a certain age and the healthcare system saves X amount of money by not paying for testing, surgery, radiation and other treatments. So what if a few older men die that could have been saved? Like me.
Every three months since 2016 when first had RP to now when facing metastatic stage 4 Pca. I feel most comfortable with this shorter time between tests to assur ee can detect rises and trends sooner.
Uk, 10 years since RP, still every 3 months as very slow rise. I did move to 6 months for one or two after a couple of years, but then got to 0.05 so they keep me 3 monthly. On the upside, they barely bother me now 😀
Metastatic de novo Gleason 8 from December 2016. Started treatment in January 2017. NOD as of August 2017 and since then (post prostatectomy, SBRT and IMRT and while on Lupron and Zytiga). No treatment whatsoever after June 2019. My MO at MSK strongly recommended on Oct. 11, 2024 that I maintain quarterly testing. I will continue with PSA testing every 3 mos.
I've had PSA tests at every 3 months are longest since diagnosis as metastatic in 2018. Many times every six weeks. Now I have a urologist and an MO so they both are in a PSA war, although I try to pass all results on to them. I don't see anything changing in the near future.
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PSA frequency 
Test monthly or three months? Different PSA results from different labs? 
PSA rise in the first year after SBRT
