What post RP, PSA is undetectable ?

Well, some would disagree with your Dr on no more treatment until.2.
My urologist as well as RO feel that salvage radiation should be considered for some when you have a rising PSA and it reaches .03. I waited until .06 before starting salvage radiation at M.D. Anderson in Houston. I am 42 months out from treatment and my PSA has been <.006 very time. Readings every six months now. Studies that have appeared here show better results if treatment is started earlier than at .2.
A longtime member here posted the studies. There might be links to those studies from his previous posts. His Tall Allen.
Good luck

That would be the traditional standard of care. New studies suggest sooner is better.

You may want to consult an RO for a second opinion.

If you get above .1, you'll want to be getting your RO consults done.

Andrew

Old Beek... time to say goodbye to your uro and find yourself a good RO and a good facility that has the top of the line radiation equip and the best radiation team!! JMHO from my experience

Larry

Oldbeak, as a pT3aR0 your are negative for any adverse pathology, so it all comes down to your PSA at this point. The urosurgeon who did my RP also used 0.1 as the cutoff for undetectable, but also recommended ART based on my SVI. Your case will require microPSA's even though that is not strictly by the rule book.

My new Uro when we moved to Florida immediately referred me to a RO, who managed my case from then onward, other than PT for continence and all that entailed. My RO stated that I did not need to get an MO on board.

As others have said, your Uro's job is done, other than doing footwork drawing blood etc. A RO should be calling the shots now. If your PSA is rising, you need to know that as soon as possible to allow early intervention. It sounds like your Uro is simply following a script.

My URO says no further treatment is needed till .2.

that's the kind of laid-back thinking that maximizes the chances of the cancer going systemic. it's time to get an MO with a sense or urgency in the event that BCR is established.

Hi oldbeek,

Maybe you know this already, but you've got to take things you read on the internet with a grain of salt. Sadly, you've gotten some really poor inputs right here in this thread:

• .03 -- that's the modern consensus threshold for possible BCR — not true
  
  
• If you begin the SRT sooner you are more likely to be able to avoid ADT — not true
  
  
• as a pT3aR0 your [sic] are negative for any adverse pathology — not true (“EPE focal”)
  

Here’s my comment to you:

Everyone here who jumped onto the bandwagon of “this is biochemical recurrence & treat it early” has completely failed to also mention that the data says clearly this approach is only substantiated for men with greater than 10-years life expectancy.

At 76, you have an 10-year average life expectancy…take everything into consideration; treat the person, not the number…it seems like your urologist is onboard with that and perhaps in tune with overall preservation of QoL. At no point should the treatment be worse than the disease.

There comes a point where monitoring continues and one simply treats symptoms which may or may not eventually creep-in during your lifetime in the years far ahead. Your PSA is <0.1...possible symptoms are many years away.



From the "ASCO Educational Book," here the 2018 article titled Management of Biochemically Recurrent Prostate Cancer: Ensuring the Right Treatment of the Right Patient at the Right Time

Post Edited (Blackjack) : 11/6/2018 8:39:09 AM (GMT-7)

If my memory of the studies is correct, the .03 is NOT considered BCR, but rather (again, depending on the study there was more than 1 ) if you finally hit .03, you have very high odds of someday BCRing. Someday, but not yet. Still, some of us might like to get a head start, depending on pathology and such.

Here is one such study:
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4586061/

Somebody said...
the prostate specific antigen pattern during the first 3 years of followup to divide 566 men into 3 groups, including 1) undetectable prostate specific antigen (0.03 ng/ml or less), 2) low detectable-stable prostate specific antigen (greater than 0.03 and less than 0.2 ng/ml, no 2 subsequent increases and/or prostate specific antigen velocity less than 0.05 ng per year) and 3) low detectable-unstable prostate specific antigen (greater than 0.03 and less than 0.2 ng/ml, 2 subsequent increases according to NCCN criteria and/or prostate specific antigen velocity 0.05 ng per year or greater). The primary end point was biochemical recurrence, defined as prostate specific antigen 0.2 ng/ml or greater, or receipt of radiation therapy beyond 3 years of followup.
Results

Seven-year biochemical recurrence-free survival was 95%, 94% and 37% in the undetectable, low detectable-stable and low detectable-unstable groups, respectively

Please note that even in the 2nd group(worse, low detectable-stable prostate specific antigen (greater than 0.03 and less than 0.2 ng/ml, no 2 subsequent increases and/or prostate specific antigen velocity less than 0.05 ng per year), this group of men who reached .03 but less than .2- still 94% were BCR free at 7 years! This compared to 95% in the group who stayed below .03% for the first 3 years. IOW, no difference.

What about the worst group, > .03 plus some other negatives: still, 37% HAD NOT BCRed at 7 years.

So, getting over the .03 mark in the first 3 years ( in this study at least) is a negative, but still a bit far from a guarantee of BCR within 7 years. There are other studies with somewhat different results, showing a greater likelihood of BCR someday if ever reaching .03.

OTOH, the OP ( Oldbeek) is not .03, but .08, up from a recent .05. So the trend seems to be in the wrong direction, as well as over .03.

I think oldbeek's URO is correct. The ultrasensitive PSA tests (anything below 0.1) often causes anxiety in the patients even when the reported PSA rise is clinically insignificant. So many who begin SRT early in reality treat their anxiety and risk overtreatment. Extra money ($$$) to the RO's so they are happy to provide it? Outside the US (in countries with different health care systems) we don't often see these very early (< 0.1) start of SRT.
There is no evidence, which I know of, that the result of SRT is better if given at <0.1 instead of at 0.2.
Do anyone know of a RCT that have compared SRT started at <0.1 with SRT started at 0.2? That would solve the issue.