Delayed detectable PSA post RP

[Atlantic77]

I underwent a RALP in Jan 21 and subsequent PSA tests indicated <0,02ng/ml. However, most recent PSA test indicates 0,03ng/ml without the < sign.

Does this indicate biochemical recurrence and what is the next course of action ?

[Tall_Allen]

No, biochemical recurrence is a confirmed PSA of 0.2 ng/ml. No action is indicated unless you reach that.

[Atlantic77 in reply to Tall_Allen]

Thank you for the reply Tall_Allen. From memory, there was a trace of residual healthy prostate tissue (with no positive margins or EPE) noted in the RP pathology report. Could this be a possible source for a delayed detectable PSA or is this unlikely given the prior undetectable results ?

[Justfor_]

Isolated PSA readings don't convey much information. The fact is that PSA will rise no matter what. The information is provided by the rate of rise or in another metric by the PSA Doubling Time. The following are my personal observations:1) For two decimal points reporting the rounding error is predominant up to 0.06.

2) If/when you reach 0.06, the chances are 50-50% that you will see the nominal 0.2 for BCR within the next 2 years.

3) For a non-nonsence PSADT evaluation 6 monotonously rising PSA readings are at minimum required.

4) If you want an earlier assesment of your PSADT elect monthly tests and 3 decimal places reporting labs.

5) Silly docs and their parrots will tell you that there is no PSADT bellow 0.1 (they still live in the 90s when single decimal reporting was the norm).

[Atlantic77 in reply to Justfor_]

Thank you for the information in relation to PSA dynamics, I would be interested in following the PSADT I think, although I also hear the argument that it may only serve to fuel anxiety.

[leach234]

Same lab? Both ultrasensative? I had a PSA test as part of my General Practitioner’s annual physical and it was 0.03. The next week I had my bi annual ultrasensative test through my prostate surgeon’s lab and it was <0.02. First test was at a different lab on a different machine and wasn’t an ultrasensative test. All future tests through my surgeons office have been <0.02. The 0.03 reading was years ago.

[Atlantic77 in reply to leach234]

Always use the same lab, both ultra-sensitive (I didn't realise that tests measuring to two decimal places were classified as ultra-sensitive). Although, it was part of an annual physical through my GP doctor and not my urologist.

[leach234 in reply to Atlantic77]

Ask the lab if they’ve changed their equipment.

[Murk in reply to leach234]

Agreeing with leach234 and when I had a test reading that was suspect, I got retested.

[Atlantic77 in reply to leach234]

I will

[Boacan]

I’m on a similar path following RALP in 01/2020. Gleason 3+4 with clear margins but slight focal EPE noted and PNI. Made it 4 years undetectable via ultra sensitive PSA testing until April 2024 PSA was 0.03 and July 2024 was 0.02 - MO recommends continuing to monitor PSA until it reaches 0.20 at which time further action will be taken. MO did indicate that PSA could be a result of some healthy prostate cells that escaped but more likely it’s a result of probable BCR. MO believes this is a very slow growing situation with non-aggressive cells but no decipher test has ever been taken. Not sure what else to do other than stay on the path recommended…

[Atlantic77 in reply to Boacan]

Yes, I am learning that the SOC is to wait until 0.20 before initiating salvage treatment. Encouraging that it went down to 0.02 in July for you.

[Teufelshunde]

Only possible action to take BROQ per this study? Does not hurt.

aacrjournals.org/cancerprev...

[Atlantic77 in reply to Teufelshunde]

Interesting study, I do regularly grow my own brocoli sprouts and eat a mouthful most days so that can't be harmful. Although, I wonder does it really have an anticancer effect or is it just reducing PSA levels.

[dans_journey]

I had a radical prostatectomy with undetectable PSA results for 54 months after surgery, when I had a PSA test result came back at 0.05 ng/mL.

For the next 18 months, the PSA bounced up and down before it started a consistent upward climb. It took another 6 years before my PSA went from 0.05 ng/mL to the BCR definition of 0.2 ng/mL. Total time from surgery to hitting BCR was 10.5 years.

Throughout that time, the biggest thing that I and my medical team focused on was the trend between PSA tests and the PSA doubling time. My PSADT was measured in years, which made us a bit more comfortable in delaying any salvage treatment (and its associated side effects).

For reference, my prostate came out cleanly—negative margins, no ECE, LVI, SVI. My Gleason going into surgery was 3+3, but upgraded to 3+4 in the post surgery pathology. Also, I did undergo salvage radiation therapy to the prostate bed only with concurrent androgen deprivation therapy. Unfortunately, that has failed and my last PSA in May was 0.52 ng/mL.

Of course, no two cases are the same. My recommendation is to closely monitor your PSA every 3 months to establish a trend and see what it's really doing before taking action. If your PSA increases more rapidly, you may have to act sooner. If it doesn't, you and your team will have to weigh the pros and cons of delaying salvage treatment.

All the best.

[Atlantic77 in reply to dans_journey]

Appreciate the detailed description of your journey so far. It is disconcerting to realise how powerless one really is in the face of PCa, you just never know how persistent it is going to be. All we can do is fight back with whatever we have at our disposal as you suggest, I will monitor for a PSA trend to determine doubling time and take it from there. Projecting into my possible future (with BCR after salvage Tx) I would consider iADT with daralutomide monotherapy or maybe estradiol gel or patches. All the best.