It's been a while since I've visited this site. I thought I had moved on, but.....
It's been 17 months since my robotic protatectomy (T1C, Gleason 3+4, PSA 5.6... all margins/lymph nodes/seminal vesicles clear). Up until my latest PSA test (yesterday) my results were coming back undetectable. Yesterday's results were 0.1. Of course I immediately got on line and started reading. All indications are I don't have to be concerned until it reaches 0.2 but it just seems like a big jump going from <0.1 to 0.1 in a 3 month period. My next appointment with my urologist is 3 weeks out, until then I'd appreciate any words of wisdom.
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Scott10-10
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Don't panic. It's still a very small number. Even if it goes to 0.2, don't panic. Hopefully it has not come back, but if it has, you still have many treatment options.
It is not true that "I don't have to be concerned until it reaches 0.2 ," but that is a common misinterpretation. 0.2 has arbitrarily been set as the level of "biochemical recurrence (BCR)." This level was set many years ago before there were ultrasensitive PSA (uPSA) tests. Back then, the lowest detectable level on a conventional PSA test (like the ones you've had) was 0.1, so they set 0.2 as the BCR just because it was above that. That is really all the science that went into it.
As the uPSA became prevalent in this century, doctors have started to use it to predict if a true recurrence was in the works. Three major randomized clinical trials proved that adjuvant radiation (immediately after surgery) had better oncological outcomes than a wait-and-see approach. But adjuvant radiation would result in a lot of overtreatment. So they looked in the databases to see if there were a low uPSA level that could RELIABLY predict true recurrence. This is called "early salvage." In the study below, the authors warn:
"Our data would suggest potentially a traditional cut-off of 0.2 to define biochemical failure may be too late, and that at the first sign of a detectable PSA that SRT (or SRT + ADT) should be initiated."
What some researchers found for someone with your favorable pathology (no positive margins and no EPE or SVI) was that a good predictor is if (1) the uPSA is >0.03 AND (2) Two subsequent increases in PSA, and/or PSA velocity of 0.05 ng/ml/yr or greater.
I think it is prudent to ask your Uro to call in to your lab a scrip for an ultrasensitive PSA test. Based on that, you may want to set up your next meeting with a radiation oncologist rather than a urologist. Remember, Uros do not typically follow patients after salvage therapy. It is the radiation oncologist who has the knowledge and experience with cases like yours.
Thank you so much for your insightful comments. Now that a couple of days have passed I have calmed my thoughts a bit. What will be will be and I will cross the bridges when I come to them.
How very true. In addition, I found (find) it helpful to have 2 trusted people involved in my decision making .. in my case my partner and my sister.. since they can listen better and think more rationally.
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