My PSA after surgery was < 0.02 for 1.5 years and read 0.02 at that point. 1 year later I just got a 0.03. That's pretty certain for BCR unfortunately according to more recent studies. Not a fact PCa patients like to learn about. I know most Urologists & Oncologist typically don't recommend salvage radiotherapy until 0.2 which has been the "traditional" value for biochemical recurrence confirmation prior to ultrasensitive PSA tests becoming more common.
Studies have show adjuvant RT (but typically in higher risk groups if I recall) shortly after surgery didn't show a statisically significant benefit at < 0.2 PSA which is why even centers of excellence still don't recommend SRT until 0.2. However my thinking is there are micro metastases floating around, the longer you wait the potential for them to travel farther.
I aside from lack of study data supporting SRT < 0.2, I think the "real" reason many delay until at least that level is you typically can take a hit to your urinary (usually temporary) and erectile function when receiving SRT especially in the post-surgery setting. However I'm young, 56, my urinary function is about 90% (some stress leakage ocassionally) what it was and erectile function is about 80%+ what it was (they bi-lateral nerve sparing - can get decent erections but typically take 2.5mg Cialis to help maintain a strong one)
I could see delaying until 0.2 (or higher) if I was a lot older and the surgery had a more negative effect on my continence and erectile function or if I was at a 0.03 3 months after surgery I'd want to give myself more time to heal.
The Radiologist I consult with (Dr. Kishan at UCLA) said if I wanted to do it earlier that waiting until 0.1 should pose no additional risk in his opinion based on my theory that sooner has a chance of *possibly* being better.
I'm curious others take that have gone through a similar situation. I haven't had a chance to talk to my Urologist yet but has anyone else asked at what minimum level can doubling time calculations be considered reliable? It seems to me going to the second decimal, that's just too low to really calculate a reliable doubling time but. A quick ask of a few major chatbots returns conflicting results. Some same at least three results of 0.02 or above the DT calcs will be reliable but one response said 0.2. My gut feeling is you need to get to one decimal place (0.1 or higher) before you can get a reliable calc. Because at 0.02 and 0.03, you have no idea, did you go from 0.028 to 0.031 or from 0.021 to 0.038? But going from 0.12 to 0.15 you would have a better idea what your DT is.
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My ultrasensitive PSA tests are done by Labcorp and they take it out to three decimal places. I just got my results today and here is part of what it says:
PSA, Ultrasensitive
View trends
Normal range: 0.000 - 4.000 ng/mL
Value
<0.006
Roche ECLIA methodology.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.200 ng/mL
A few years ago Honorhealth used a different lab and my results always just said '<.03.' If you see value going out to thousanths, you can do it with Labcorp. I'm six years post RP but still always have some PSA anxiety before getting my results. I know it ain't over 'til the fat lady sings. If at some point my PSA gets up to about .06, I think I'll at least start looking into getting radiation. Good luck to you. I hope your PSA just stays at the .03 indefinitely...and I think it very well may. I read through your post surgery pathology and it was pretty good.
In your last sentence you have identified the notion of the quantisation or otherwise dubbed rounding error. Any value bellow 0.06 bears a higher error due to rounding than the claimed 20% measurement accuracy of the PSA test. There are two ways to get a more reliable PSADT estimate. a) switch to a lab reporting to 3 decimal places (thousands). b) Make use of oversampling. Averaging 10 2 decimal places values you get a non-random 3rd trailing digit. But, after this method and if we get a bit pendantic, you will need 3x10 tests. Not practical of course. My practical advice for the evaluation of a no-nonsense PSADT is 6 values to the hundreds the highest of which over 0.06. Any value preceded by a less than sign is to be discarded.
Number of reported digits has to do with the measurement precision, meaning that printed values are coherent to their entierty. If a measurement is repeated multiple times, under the exact same conditions, the results should be the same to the reported length and not include trailing parts of random digits. Accurate and to which degree such a measurement may be, is a totally different identity.
Does "Have yet to experience an error" mean that all 3-decimal results were the same, in all 3 decimals places? I find that remarkable -- after all, your body _does_ change through the years. If you mean that they showed slow drift, without any outliers -- that shows really consistent lab work and instrument calibration.
Yes, consistent lab work and instrument calibration. If we did not have these and instead had significant differences, which result is correct? The one we like best?
I provided a bit of my pre-Dx PSA fluctuations in my reply to Poster jazj. My uPSA results since last December: 0.037;0.031;0.037;0.030;0.033;0.030;0.025;0.031. This summary is from my bio:
<0.010 Mar '18-Jan '20
0.01X range Feb '20-Oct '20
0.02X range Nov '20-May '21
0.03X range Jun '21-Present
I expect change in thousands value. My attention is on the hundredths value - I am in no hurray for mine to move up to 4 (.04X). One explanation I accept for slight variances is hydration level. I do accept cancer cell volume is part of this as well - I do not see cancer growth as strictly linear.
I wish to note your bio is empty and you have no posts - but a lot of replies. I gave thought to your reply to me being a troll. I appreciate there is opposition to uPSA testing, including strong voices in this group, but this is okay as I like discussion and debate.
I too just didn't want to wait to give it a chance to spread, plus I was not getting any younger. So after three years of my PSA measuring at <.1 and tested every three months, it bumped up to .1 ng/mL. I then went to the Ultrasensitive PSA test and within 2 months it went from .099 ng/mL to 0.137.
So I elected for salvage radiation with ADT. Just didn't want to wait...
I have been holding 0.03X range for past three years six months. As with my post RP nadir of 0.053, (nine years ago, 58YO), I do not question whether cancer remains. I ponder where it is and how fast will it spread to an incurable stage, requiring ADT.
After my RP I waited until 0.11 (took 11 months) for salvage RT to prostate bed, shooting blind. Nadir 0.075. We missed!
Waited again until 0.13 (13 months) for salvage extended pelvic lymph node surgery using frozen section pathology method. Six cancerous pelvic lymph nodes confirmed including common iliac and para-aortic. Nadir, <0.010. That was nearly seven years ago.
I learned to not give this beast time and obscurity. And I am learning this lesson again as I now deal with metastatic liver melanoma following "successful" skin melanoma surgery six years ago, which had "clear margins" and 'clear' sentinel lymph nodes. Hope this helps. All the best!
Do you have any guess why your PSA went from 0.01 nadir and then has apparently paused at 0.03? Did you make any lifestyle changes, diet changes or start taking certain supplements after a few years back? Or start on new prescriptions even if not for prostate cancer?
Seems as if guessing is all we have. Alternatively, I could adopt the view that BCR is 0.1 or 0.2 and stop uPSA testing for an assay that reports no lower than <0.20 or <0.10. For these past seven years this would be my result and I suppose I could claim 'undetectable', maybe 'cured'. More seriously, my guesses:
Thinking in terms of lingering cancer stem cells, senescence, micro mets, or whatever we might call remaining cancer (above my patient grade), I significantly stepped up my fitness level, upgraded my already 'decent' diet and began a supplements regime (details in bio).
My cancer seems to grow/spread slowly; one question is when did it begin? My PSA screening began in 1998 at 41YO and rose slowly through the 'normal range' until 2003 when I had a crazy spike to 20.4. That came right back down then my PSA bounced between values of 4 to peaks as high as 10 through my diagnosis in 2014 (57YO).
My post ePLND nadir of <0.010 was certainly welcomed but I did not think in terms of being cured. What I did think was that the removal of significant remaining tumor burden, six cancerous pelvic lymph nodes, was significant. After much consideration I then did one year of bicaluatamide as added insurance, maybe setting any remaining cancer further back. That treatment completed 5.5 years ago.
These are the guesses I have. All the best to all of us fighting this beast!
My understanding is the only 'major' US center offering salvage ePLND using the frozen section pathology method is the Mayo Clinic, Rochester. I traveled to Europe for mine a far more common procedure there. The cost was more than reasonable and we made a medical holiday of it.
Well, consider me subscribed to this thread. I'm 47. Had prostatectomy 9/26/2023. My urinary and sexual function post surgery comparable to yours. PSA post surgery was < .02 ng/mL aka undetectable for a year. Then:
10/1/2024 - 0.02 ng/mL
11/1/2024 = 0.03 ng/mL
Had the same question about doubling time, thanks for asking and glad I'm paying attention to this forum.
I have meeting with medical oncologist at Fred Hutch on Tuesday to discuss.
Q: I know that it's unlikely that a PSMA PET will find anything with a PSA that low, but will you try still? And at what value? And with which agent?
Q: ever gotten a blood biopsy?
Q: I've seen you asking about ADT, but you've presumably never been on ADT to date, correct?
Yes, night sweats The oncologists considered my pathology very favorable so ADT wasn't considered really necessary. Again I weighed in and was proactive after doing a lot of my own due diligence. The Salvage Radiation slighrly burnt my bladder, apparently. That's another story for another time for the story is unfolding. I FEEL GREAT
Stance on ADT with SRT has changed over the years as you oncologists were aware of. It has been shown to have no benefit for overall survival and the benefit for Metastases Free Survival was significant but small.
Radicals HD trial supports this.
"Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population."
"10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. "
I've seen reports that ADT can weaken the cancer to make RT more effective but that hasn't translated to increase chance SRT is curative as otherwise logic dictates it would then show a significant increase in overall survival in my mind.
ADT to me is essentially a pause button but in the long run the cancer appears to "catch up" even if you paused it. It is no surprise if you did a 24-month pause you would delay metastases.
If you have bad pathology and short doubling times I think doing ADT with SRT for delaying metastases has some benefit though.
Hello Dear, I'm calling you from the lab and guess what? They said my Psa score is based upon my periods and places...... does that mean I may be pregnant? (Oh Honey, tonight can we have pickled watermelon rinds for dinner?)
Our stories are similar. Diagnosed at 52 and had a radical prostatectomy (Gleason 3+4, came out cleanly—negative margins, no ECE, SVI, LNI). PSA undetectable for almost 5 years when it came back at 0.05.
My PSA bounced up and down between 0.04 and 0.08 for 18 months after that initial detectable PSA reading, and we were comfortable just monitoring it during that period.
But then it started a very slow upward climb. It took 6 years to hit 0.2 with my PSA doubling time being measured in years. (BTW, the Memorial Sloan-Kettering PSA Doubling Time calculator requires values of 0.1 or greater.)
Like you, I was concerned about salvage radiation side effects, both short term and long term, and because my PSA was rising so slowly, we agreed to just monitor.
When my PSA hit 0.22, I went for a PSMA PET scan and that came back inconclusive at that PSA level. I really wanted the radiation oncologist to know where to zap instead of blindly zapping the prostate bed, so I was disappointed in the result.
The increases in my PSA began to accelerate, so I opted for SRT with concurrent ADT to the prostate bed only. I was given a 6-month dose of Eligard 8 weeks before starting SRT. My PSA going into SRT (before the Eligard) was up to 0.36.
I did 35 sessions (70 Gy) of IMRT to the prostate bed only. Nine months after SRT ended, my PSA hit a nadir of 0.11. Fourteen months after SRT ended, it was 0.21, and now, 27 months after it ended, it is 0.69 (tripling in a year).
Side effects from the Eligard included: mild to moderate fatigue; hair-triggered emotions; thinning of body hair; and reduced libido/sexual function.
Short-term side effects from SRT included: fatigue, especially during the last 3 weeks and for 4 weeks after SRT ended; and increased urinary frequency. Long-term side effects from SRT include increased urinary frequency (but not as bad as during the SRT), and now it appears a mild case of radiation proctitis (occasional signs of blood in my stools; colonoscopy next week to confirm). Sexual function has returned to pre-SRT, post-RP state.
Did I wait too long to start SRT? Should we have done whole pelvis radiation? Who knows. My rising PSA would probably say yes to both. For me, being side-effect free for 6 or so years before SRT was important. It allowed for a higher quality of life and I got to do a lot of things that I wanted to do.
Personally, given the stats in your profile, I think that acting on a PSA of 0.03 without establishing a true trend would be premature. I'd encourage you to get at least 4 data points taken 3 months apart to see what's really happening before jumping into SRT.
I anticipate I will forego SRT until two successive rising reading of 0.05 or above. My Urologist I met with last Summer 6 months after it became detectable at 0.02 said UW uses 0.03 as detectable and that looking at my pathology and PSA readings said it could be as long as 10 years before I hit 0.2 (I think that was an overly optimistic number to keep my hopes up)But if it's going to jump up and down a bit at the < 0.1 level, great, I'll just keep watching.
With initial PSA if 31 with my 20% Gleason 4 having cribriform pattern, that put me in the High Risk group pre-surgery. I'm not waiting until 0.2.
Also think I'll get my Decipher score although not sure insurance will approve it prior to a 0.2 PSA?
I have bounced around for years, max 0.12 latest 0.11 - see my bio. But I would say no discernable doubling time, maybe 7 years or so which i dont find too worrying. Not racing into SRT until I have a clear DT. Yours could be 0.024 followed by 0.026 just rounded, but keep up with testing schedule.
"After prostate removal, if benign prostate tissue is left (for example, at the junction with the bladder or at the urethra) this can grow and cause the PSA to rise."
"The presence, anatomical location, and extent of benign prostatic tissue at the margin were correlated with clinicopathological characteristics and postoperative PSA increases."
Maybe this is partially why they don't recommend SRT until 0.2? You may be a case in point! I may rethink doing SRT < 0.15
Interesting that there's a reference to a *rise* from benign tissue. I had previously thought perhaps there could also be some left behind from the nerve sparring I had on one side. The 2nd ref finds no link between remaining benign tissue and BCR too, which is good. After nearly 10 years I am now fairly relaxed about the 3 monthly tests, but still am accepting that SRT may be needed. I could have rushed into it but as I had main RP side effects I am now more cautious.
Interesting references as I have wondered if benign prostate tissue left behind could be causing PSA to reappear at very low levels following RALP. I was undetectable for 4+ years when uPSA returned at .02 and has remained in that range (.02/.03) for almost a year. However, my pathology showed clear margins but slight focal EPE was noted.
Curious when a couple of folks above refer to their PSA 'bouncing around'? I have never seen any evidence of this and rarely hear it mentioned. It only goes up unless you different labs and assays had an influence. The latest generation super sensitive assays are the only way to go.
To write "It only goes up unless you different labs and assays had an influence" is a false statement. Not because of the grammar - I get what you are saying.
With cancer spread the biggest challenge is how far have tumors, including micro mets, spread. And what of blood traveling cancer cells?
If you mean by supersensitive to 3 decimals or reporting levels below 0.02 I don't see any rationale for that level of information to be actionable. I would venture to guess 90%+ of those on here didn't do salvage therapy after surgery until> 0.1 and the majority => 0.2. Getting a reading of .024 or .328 versus 0.02 or 0.33 really has no benefit.
In fact 3 decimals results usually just cause unnecessary anxiety especially below 0.02.
Steve507 - I read your bio and noted you opted for SRT. Your reasoning is understandable given the positive margin. Did the SRT consist only to the prostate bed?
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Big decisions regarding SRT and ADT for BCR
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