RADIATE OR WAIT ? PLEASE HELP !

Welcome to HW
That's not a lot of PSA - many of us and a lot docs consider that effectively a zero. The ultra sensitive test seem to just generate anxiety not actionable results.

If it were me I'd be out having a party to celebrate my good fortune.

Keep testing. You should be concerned about the long term trend of the PSA and the doubling time. A .002 rise in 2 months could be within the margin of error for the lab and effectively you've still got no real problem to worry about.

So, if those were my test results, I'd be at the bar buying drinks.

If your PSA ever gets close to say .2, call me, I'll buy the beer just before you get SRT.

I'll have a beer,
Andrew

Welcome OMR, glad you dropped in.

I'll simply say "Amen" to what both Chris and Andrew said - no worries on your current stats, keep an eye on things until/if you ever have a true BCR.

Get back out there and enjoy life!

There are no rigid rules, but post-RP the standard PSA test for monitoring is typical for men with intermediate- or low-risk cases and negative margins.   Men with positive margins and/or high-risk cases are more typically given the more sensitive PSA test for monitoring.   Again, this is only a common sense “rule of thumb” and one could certainly find examples which don’t follow that… The AUA is the definitive source of the definition for post-surgery biochemical recurrence (BCR).   The AUA has an easily-readible, free online document which would be of direct interest to your thread.  The document is titled:  "Prostate Specific Antigen BEST PRACTICE STATEMENT:  2013 Revision of the 2009 Update" , and is found HERE . It reads: The AUA defines biochemical recurrence as an initial PSA value =0.2 ng/mL followed by a subsequent confirmatory PSA value =0.2 ng/mL.   However, a cut-point of 0.4 ng/mL may better predict the risk of metastatic relapse.   This cut-point was selected as a means of reporting outcomes, however, rather than as a threshold for initiation of treatment.      Your numbers are far below this.  The purpose of the ultrasensitive test is to give those with higher risk of recurrence (like positive margins) an opportunity to monitor more closely whether it crosses the BRC threshold or not.  As you can tell from the AUA statement, they do not recommend action prior to BCR.  Your tests may be picking up naturally occuring variation.  Relax   I hope that this information adds value...      

I'm a G9 (4+5) with positive margins and EPE in multiple spots. Even then my uro will not, NOT do ultrasensitive. Unless there is a reason to worry early (I had lots of those, you have few), you likely couldn't even get an insurance company to pay for treatment until you meet the required 2 consecutive rises after hitting .2. If your uro is talking about it, he is probably just trying to make sure you won't potentially be surprised a year down the road.

We have folks here who went slowly up to .4 / .5, and then stabilized.

Take it easy. Remember that you will never have a truly zero PSA, and that labs use different tests and equipment. Two blood samples sent to two labs on the same day can be expected to have different results.

Did I say take it easy?

 

OMR,
I agree with what everyone else says. These readings are way to low to be indicators for starting salvage radiation. However I will note, that some doctors recommend adjuvant radiation for some of their patients soon after surgery -- Personally I would be reluctant to go ahead with any kind of post-surgery radiation without a clear sign of biochemical recurrence.

After my open RP I had very slowly increasing PSA readings over a period of 7 years before I was clearly in BCR, and only then went ahead with SRT. Also my PSA increase over those years was not a straight-line rise. I stayed at 0.02 for 3 years, then stayed at 0.04 for nearly a year, then hit 0.1 and stayed there for 3 full years before I hit 0.2 -- after which I quickly doubled to 0.4 in only 4 months.

My point is that I was able to go without any follow-up radiation for 7 years. I then went ahead only when I had a sudden acceleration in PSA numbers and also hit 0.4, which was a number I didn't want to go past without starting salvage treatment.

I'd ask your Dr. to allow a monthly PSA reading at the least to see any pattern. My Medicade Uro Dr. won't allow monthly testing so I have found ways around that to give more information as to my PC.

Can you get a 2nd opinion from a PC oncologist?

I'm glad that your levels are that low to date. Also glad that you are here and able to express your concerns. Knowledge is power.

A urologist will usually recommend surgery, a radiation oncologist will usually recommend radiation. So get a medical oncologist from a national PCa center who has no skin in the game to be the QB of your medical team.

My understanding is that standard PSA test is most accurate in the 4.0 range and ultra sensitive is most accurate in the 0.1 range or so. So your low scores may be the reason for the switch.

With your metrics, time for the sage advice - don't just do something stand there as opposed to its counterpart don't just stand there, do something.

T1cN0M1b-in-FL said...
A urologist will usually recommend surgery, a radiation oncologist will usually recommend radiation. So get a medical oncologist from a national PCa center who has no skin in the game to be the QB of your medical team.

My understanding is that standard PSA test is most accurate in the 4.0 range and ultra sensitive is most accurate in the 0.1 range or so. So your low scores may be the reason for the switch.

With your metrics, time for the sage advice - don't just do something stand there as opposed to its counterpart don't just stand there, do something.

 

Those 1st two sentences are key and correct IMO. A medical PC oncologist is a great idea.

When 1st diagnosed, I was afraid and very emotional. I felt those emotions for about 2 weeks and then got angry. It was an anger that involved finding out all that I could about all things PC. HW was a huge aid. Then I got proactive and asked questions to various DR.s even having no insurance nor money. KNOWLEDGE eases Trepidation.

Post Edited (Trepidation) : 7/12/2013 2:43:20 PM (GMT-6)

Cowper's gland -

Gotta admit I never heard of that gland which apparently has a synonym name

http://en.wikipedia.org/wiki/Bulbourethral_gland

OMR, I just re-read your original post, esp the part about "Well my last PSA test came back detectable at 0.028 and follow up psa test 2 months later was 0.03, tested by different laboratories ( ultrasensitive psa tests ) and my urologist is talking secondary treatment."

IMHO that difference is simply due to just measurement noise, which means equipment capability, and that would include the assays used and the associated calibration standards. Add to all of this that your two tests were done by two different lab's and it seems pretty clear to me that level of change is due more to the confidence level / capability of the equipment(s) used!

Stay on top of things, sure, but I just don't see the need to panic here.

I'd wait. Mine went up to 0.22 and my SRT seems to have worked. No sense in rushing it.