Minor psa increase again

[Runner1957]

Just over 12 months since adt finished. All clear at <0.01 2 months ago when it started to rise to 0.03 then 4 weeks later 0.05 now 0.07. Have Dr's app in 3 weeks which will probably be a referral back to oncologist. Do we need to wait until 2.0 then a PET scan or can I be proactive now? My adt was for 18 months, should it have been longer. 2nd recurrence so looking at advice before I meet oncologist??

[lpol83712]

You have 3 rising and are status post RP and then radiation so recurrence is suspect. You don’t need to wait till PSA is 2 but the sensitivity to pickup areas of spread on PSMA Pet is pretty low less than 0.2. So if looking for places to radiate you probably need to wait. Certainly starting ADT with an androgen blocker now is not unreasonable. Dr Kwon has a prostate combat manual series on YouTube with 5 videos discussing more on recurrence ( he is at Mayo Clinic). Watching those should have you well prepared with information and questions for next visit

[Justfor_]

I have written like 100 times that the PSMA PET/CT detection capability at low PSA grossly relies to PSADT. From your posts I can guess that your PSADT is very short of the order of 1,5 to 2 months. By the time you visit your MO your PSA can be approaching 0.1. Off the top of my head, under such conditions PSMA scan can have a detection probability of 40%, maybe more. Silly docs and their parrots will tell you to wait further. Your life, your decisions.

[Murk]

Personally I hate not doing anything when you know things aren't right. When they say wait to the magical 2.0 PSA level its bull shit cuz what they are saying is to wait for it to show that its Matastazing.

I don't know the right answer but I would get back in the face of my RO and say WTF and what do you recommend doing right now. Then I would get a second opinion and ever see a MO and get there opinion. You are at war and don't hold anything back. Stop being nice and start pusing for clarity and going forward plans. All just IMO...

[Still_in_shock]

Waiting for 2.0 is for men WITH prostates.

Men that have had RP, should follow up at 0.2

Any changes under 0.10 I would not worry until it surpassed that, then consider the doubling time.

Are you using the same lab? Does the lab offer "serial monitoring service"? That assures the same assay methods, and controls for accuracy.

What lab offers <0.01, the best Quest can offer is <0.02

[Cetma in reply to Still_in_shock]

Seems few years ago Labcorp was using <.006 however, these days, ya, I think its changed back up to <0.014 versus Quests <.02

I have seen in the past other small high-dollar labs going down into the 4 digits, totally bogus and unnecessary!

[ManuteBol1 in reply to Still_in_shock]

my Labcorp test in the US last month was <0.006 threshold. I’ve seen others that posted a higher threshold for Labcorp, however, so I’m not sure it is consistent in all locations. I had Quest in January and it was <0.02 as you say.

[Still_in_shock in reply to ManuteBol1]

Just had a Quest it came back at <0.02!!! Stopped Abiraterone 2 months ago due to my first BAD Afib. Only on Lupron now.

[JWPMP]

My husband is being treated at UCSF. He has his prostate, but recieved HDR BT and no other RT, due to numerous factors. He is on ADT/HT for life. When they offered him a vacation, his MO said they would order a scan when his PSA reached 0.20 He elected to not take a break. But the trigger for action was quite low, even with a prostate. He has been <0.02 for about 3 years and is halfway through his 4th year of treatment. FWIW. Hoping you have many more years of remission.

[jjpeabody]

Runner1957, I had PET scan at 0.12 after PSA started to climb post RP. An intense uptake was noted in surgical bed and nowhere else. I get an ultra sensitive PSA test at Labcorp, last result 0.006. These are personal choices and like them, but of course appreciate all the opinions here and professional ones like Kwon, Scholz, UCSF, etc...a lot of good food for thought out there. Good luck friend

[NanoMRI]

I chose to not wait and give this beast more time and obscurity. I have been holding 0.03X range last three years, no ADT, and have coming up annual imaging and blood biopsy testing.

[j-o-h-n]

You're a runner.......... so run right off to see your M.O. (or a new/better one) and tell him you just ain't jogging......... you need answers...

Good Luck, Good Health and Good Humor.

j-o-h-n

[bagogeo]

I would not wait till it reaches 0.2..I would request for a psma-pet scan if insr will cover it..and would go on orgovyx ,again if your insr covers it.