is psa 0.1 a concern

[Murphpup]

Hi I am wondering if 0.1 for a psa is considered detectable? We are testing Psa every three months and it has been .006 for the last 18 months. We went off ADT in July of 2024 to see how he would respond psa in October .006 most recent 0.1. Trying to stay present in the moment but scared.

[Tall_Allen]

I think what you mean to be asking is whether it is a biochemical recurrence. It is not a biochemical recurrence, which is 2.0. It may be his testosterone returning to normal after hormone therapy.

[Murphpup in reply to Tall_Allen]

three months ago now it is 350

[street-air in reply to Tall_Allen]

isnt bcr 0.2

[TottenhamMan in reply to street-air]

If you’ve had your prostate removed a BCR may be 0.2. If you’ve had ADT & radiation in lieu of surgery, a BCR is 2.0.

[street-air in reply to TottenhamMan]

oh he didnt say it was radiation and i did check bio

[Tall_Allen in reply to street-air]

Not for primary radiation.

[Justfor_]

Attempting to quantify a possible rise between two tests with different reporting granularities is futile (apples to oranges).

[Xavier10]

Yes it is detectable but that is not a significant finding for a radiation patient. You should also provide the testosterone level. the two often go hand in hand in rise for a short bit. Then PSA levels off.

[Huzzah1]

My Large hospital group stopped reporting anything below 0.1 a couple years ago. Now the reports say >0.1. The reasoning is that nothing below that means nothing. There is nothing to be gained by knowing that the number went from 0.03 to 0.06. They would do nothing with that knowledge. It's not until the numbers start moving above .1 that they would really start to track it. And not until it was well above that that they would start to consider a plan of attack. I like the new approach, a lot less anxiety when the micro numbers move, there's nothing to be done yet anyhow.

[SimMartin]

I know all that’s been said above is true …. My PSA was reported as <0.01 3 months after 17 months of Zoladex and RT with a testosterone of 0.8 then at 6 months it was reported as 0.03 with a testosterone of 2.8 but of course different range but still it’s easy get anxious - next week is 9 month test and naturally I’m anxious- keen to get my T back (which I do feel is happening) but then cautious as it may raise my PSA and even if it’s not an indicator of BCR it’s in the back of our minds - so I see the logic of not reporting below 0.1.

I do have one issue though as I had no BPh and my prostate was only 30cc BEFORE treatment with HIFU and the RT - I contend that a much lower threshold for evidence of BCR is likely in my case as there is less prostate tissue than most so a small rise is more likely to be PCa cells.

Not that it is useful as PSMA needs higher levels and would not probably need active treatment anyway until it rose much more. All the same anxiety is DEFINITELY one if the major problems for many, if not all of us !

[VictoryPC]

Don't be scared be the little numbers. Stay on them.

[Doctorsceptic]

Hi. I too absolutely hate having my PSA checked. It does raise one’s worry level!

By “detectable” I think you mean is it significant. Yes, it probably is but still very low.

Can I suggest that you and hubby talk to the oncologist and agree at what level he should consider restarting ADT? It sounds as though the uncertainty is what is causing anxiety.

You may already know this but some patients do choose to have intermittent ADT rather than continuous. There is a small difference in effectiveness but perhaps better from QOL point of view especially if the CaP is of the more indolent type.

It is perhaps worth making you aware of a large trial comparing standard ADT versus Estradiol HRT patches (PATCH trial) from UCL London. Estradiol was just as effective and avoids side effects of standard ADT (osteoporosis, metabolic syndrome, etc) with significantly better QOL. Worth looking up. Main side effect is breast enlargement but that is easily dealt with ! Not yet widely adopted but the Marsden now has it on their formulary . In case you are not UK based that is the biggest UK cancer centre .

My mantra is quality of life beats quantity. Carpe diem, because none of us can predict the future.

[petrig]

In europe:Post-operative monitoring is based on PSA measurement. After radical prostatectomy, PSA levels are expected to be undetectable (< 0.1 µg/l) 2 months after surgery. After surgery, the limit for biochemical recurrence is considered to be 0.2 µg/l, and an increase in PSA to > 0.4 µg/l after surgery is the best predictor of the risk of developing metastases. In outpatient follow-up, even a single increase in PSA to a measurable level is an indication for referral to specialist care. After radical radiotherapy, PSA decreases more slowly than after surgery. After radiotherapy, biochemical recurrence is considered to be an increase in PSA of 2 µg/l above the nadir after treatment. This definition also applies to patients who have received hormonal therapy. When the patient's follow-up is transferred to primary care, specialized medical care should provide instructions on the frequency of PSA monitoring and PSA values ​​in connection with which the patient should be referred to specialized medical care.

[JobViktor]

Agree, thanks for your valuable information.

[EdBar]

I had my prostate radiated in lieu of surgery early on and I was undetectable for around 6 years but I never stopped ADT. once it became detectable again, around 3 years ago it was a sign that there were some cells that had figured out a work around to the ADT. I had a PSMA scan when PSA reached 0.2 and it showed a tumor on a rib which I had radiated with SBRT. My PSA fell to nearly undetectable again. I’ve done this twice over the past 3 years each time it was a tumor on a different rib. I plan on continuing to play whack a mole as long as possible. My MO, Dr. Sartor says that I can do this indefinitely depending on number and location of tumors. I’ve never stopped ADT though, I’ve been given the option but had docs tell me if it works why mess with it.

Ed

[j-o-h-n]

LIVE!!!

Please update your dear Husband's bio. It helps him/you and will help us too. Thank you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[Hawk56]

As others have said, yes and no.

What may be helpful is any lab results since he came off ADT in July 2024 and which form of ADT was it. The PSA and testosterone would be informative to members on this forum in determining their answers.

A 2nd piece of data which may be useful is are you using the same lab?

If te latter is true, then a rise from .006 to .1 may indicate recurrent activity.

The question is, do you take action now, if so what?

I only speak of my experience, given the heterogeneity of PCa, may not fit his.

My medical team and I have decision criteria in place when going off treatment:

We do labs and consults every three months.

Three or more consecutive increases ion PSA constitute likely activity of a recurrence.

We wait until PSA hits between .5-1.0 to provide a greater statistical probability of a PSMA locating recurrence.

Informed by that decision, we decide on a treatment.

In April 2023 when that criteria was met, we opted to do SBRT to the PLN identified ion the scan and 12 months of Orgovyx. There was discussion about whether to do 24 months of Orgovyx + Xtandi, in the end, we decided on the 12 months of Orgovyx, hold the Xtandi if PSA dropped to undetectable in the first three months and decide at 12 months whether to continue the ADT.

I came off treatment after 12 months. Was it the right decision, we'll never know but labs last week say so far, yes, nine months off treatment ande holding steady at .03 with T recovered to 400+

Discuss with the medical team:

Is there are clinical reason to treat now, if so, what do they recommend?

Is there any risk in waiting and the PSA continuing to rise?

Do they believe imaging can inform the treatment decision, if so, at what PSA do they recommend he do so?

There's no doubt that clinical data such as you describe can make it challenging as you say not to "be scared." At that PSA, there is not an immediate danger, you in all likelihood have time to discuss the way ahead with his medical team, develop your decision criteria and will have choices on treatment that may again be for a defined period.

Kevin

Clinical History

[Cold77 in reply to Hawk56]

Hey Hawk, I really like your PSA time series, but am unable to read the time scale. Do you have another version with the years in a larger font? There are likely others of us who would really benefit from your plot where (maybe?) January of each year is displayed.

[Hawk56 in reply to Cold77]

Yeah, I'll play around with it, it's a MS Excel Chart

[SsgCulldelight]

Hi and it is, but don't be worried your psa should rise a bit from time to time because you still produce testosterone, know that androgen therapy arrests the cells it doesn't look them, your body makes waste of those that are radical. It's the balance that causes the issue when produce to much testosterone and your body can't throw it off fast enough. Do your research my friend, drs have a habit of scaring patients with numbers that they know very little about abs No your not stupid your very smart, that's why you asked the question. Keep Goin friend, keep Goin. Cheers

[TJGuy]

Looks like your husband had a RP, then pelvic radiation when recurrence occurred.Was on ADT for multiple years, was either .006 or <.006 at his nadar on ADT.

Off ADT PSA rising.

So when PSA testing could only see to 0.1. They defined <0.1 as "undetectable".

We can "see" well below 0.1 these days with some tests measuring to .006 with a LabCorp Ultra sensitive PSA test.

The arcaic 0.1 and "undetectable" are still used, be it improperly by cancer doctors and institutions.

So yes under your conditions you are seeing a rise in PSA and you can determine there is recurrence going on below the "official" 0.2

Your in Minnesota so you are very lucky to be close to MAYO clinic in Rochester MN.

Your at a point where you should be getting ultra sensitive PSA testing to .006 at the same lab to see your rise. You could get this every month at this time to determine the best time to get his next PSMA scan.

As your husband come off ADT which can take up to a full year, you can see a rapid rise in the initial months that represents PC cell that were "sleep" under the effect of ADT awakening, now that ADT may have killed some PC cells as well.

If I understood you correctly his most recent PSA test was .350

So when to PSMA test will be determined by a few things. There is typically a insurance three month period between approved paid for PSMA tests. Meaning of you get one today, the earliest you can get the next one is in three months.

When the test will be able to find matastaies depends on in general how few matastaies he has. The fewer mean more of his total cancer is in fewer places and easier to detect than compared to him having many tiny cancer locations

PSMA tests can pick these up usually by 0.5

Don't worry if you need to continue to let the PSA rise to 1.0 or even 3.0 or higher. But finding them with PSMA testing I would consider critical and then taking action with most likely radiation, but a cancer hospital like MAYO will present multiple choices to you. I also go to MAYO, which I travel to from the Southeast.

I would ( and in fact I do ) stay away from ADT while letting your PSA rise and locating the PC locations and subsequent likely radiation.

You can be off ADT for great periods of years or potentially forever under this approach. Everyone's cancer is different and you'll get to know yours.

[Murphpup in reply to TJGuy]

May I ask who you see at the Mayo?

[OuttaTime]

being scared could raise your psa I am told have to get rid of stress. What does your doc say? Mostly mine is around those numbers up annd down but below .99 and I think they say it is undetectable I think. (Pray, hope and don’t worry Padre Pio.) Don’t be scared! Stay busy or rest! You will be OK!