After TX with solid good PSA numbers when to stop testing?

It's something worth thinking about, but not now if you don't plan to stop testing until your late 70's. You and I have both made it to age 70--a wonderful milestone. The rest is gravy.

I am still on a short leash with quarterly tests due to the high risk dx. My doc hasn’t indicated when we might lengthen the duration. Most docs seem to use Hal’s approach for the low and intermediate risk men. If you are always going to have blood drawn for other reasons at least once a year why wouldn’t you include PSA? Isn’t knowledge the basis of empowerment?

Prato: That is kinda where I am heading on this. Yes, a very personal and individual decision for sure. I think I would prefer not to know what is in the "wings" once I reach 80 or so.
I was just curious how others are feeling about this for themselves. I do believe it is something that each of us need to fully think through before the time arrives.

Roger

As others have said, it's a personal decision. I would still get at least an annual test if I were in your situation. My experience has been erratic PSA, both after surgery and after SRT -- years of very slow increase followed by sudden rapid acceleration.

Jim

I'll probably keep getting the PSA tests forever along with my regular annual testing. That does't mean I have to act on the results but, like JNF, I feel knowledge is power...

Jim

Great replies................................Just all I wanted was to hear what others had to say.
Thanks guys!
Roger

This is an interesting discussion and one that I have thought about a lot, especially since the AUA and other organizations do not recommend routine PSA screening for men over 70 unless they have been treated previously for prostate cancer.
It’s difficult for me to understand the logic for why the men who have been treated would need to continue with annual testing whereas men who have never been diagnosed can stop.
Why would a man whose last treatment was 5 years ago and his PSA consistently demonstrates that there is no evidence of cancer, assuming he’s not taking HT, need to continue with annual tests but another man who’s never been diagnosed with PC and whose PSA has always been normal and had no suspicions at last DRE can stop? It seems to me that the man who’s never been diagnosed has a greater likelihood of having PC than the man who has been treated and shown the treatment to be effective.
It’s been shown that the odds of an untreated man over 50 having PC generally parallels that of his age. So that man of 70 would have a 70% chance of having some cancer if his prostate were to be examined thoroughly. Yet the man who has been treated, shows no evidence of cancer, needs to have a PSA test. Why is that?

Wouldn’t it be great to be able to stop testing? No more worries about cancer. Living life as if this never occurred. The thought has crossed my mind.

The trouble, for me, with this, is that, it’s not something I can do...responsibly. “To thine own self be true”.

But forget about the waxing philosophical. It just scares me (or maybe, “on my mind” is better put) if I do not know what’s going on. Yes, the tests scare me. And the test keep me “in the line of fire”. It’s just something I “can’t not do”.

I’m 60.

Hrpufnstuf: I fully agree....it seems the AUA has it backwards.

A lot of really thoughtful replies, which is what I was looking for.

I guess what it really comes down to is "When does an individual take TX options off the table"?
I haven't reached the point of saying no more treatment but when I get to the point I will stop testing. I understand that we are all different and some guys want to know what that bugger of a PSA is doing even if they aren't going to treat. Me, I'll just forgot the whole thing and live what I have left and deal with what comes along when it comes along. Who knows maybe that jealous husband will get me when I'm not looking.

Thanks guys for a great discussion.
May we all be well and have the outcomes we are hoping for.
Roger

The natural history of PC to which Blackjack referred is simply how PC can be expected to progress if left untreated. That seems to have more relevance to the 70 year old that has a long history of normal PSA but has a 70% likelihood of having some PC and not to those of us who have been treated. The AUA proposes that his PSA tests provide no benefit to him because the odds of him having life threating PC at that age are very low. I can see that logic; PC probably is a very low threat to him. But, conversely I can’t understand why the treated man with no evidence of disease for 5 years or more, over age 70, is more likely to progress. It seems logical to me that he’s less likely to progress. But the AUA recommends he continue PSA testing, presumably for life.
I have friends who are about my age (73) who have never been diagnosed with PC. They’ve had PSA tests for 20 years or more, all normal. The AUS says no further PSA testing is necessary. I have other friends, some of whom were treated 15+ years ago and show no evidence of cancer. The AUS says they should continue with PSA testing.
In January, 2020 it’ll be 5 years since my treatment. If my PSA falls to <.50 at some point, I think I could conclude that I may not be cancer free, but I’m not at a greater risk than the guy my age who’s never had a positive biopsy for PC. Does the AUA believe that I still have a 70% chance of having cancer too?
Blackjack, rather than simply calling us uninformed, why don’t you enlighten us on why continuing PSA testing for life is logical for us and not our counterparts?

Redwing: Extremely well put.
Roger

I wouldn't suggest suspending testing for anyone who has had PCa treatment and was other than low risk, even if they have had years of undetectable results.

I had salvage radiation in 2010 followed by 4 years of quarterly PSA test results of 0.00. I guess I might have stopped testing then or maybe if perhaps the 0.00 persisted into year 5, but that would have been a bad choice for me. PSA became detectable again in 2014, though it stayed at low levels for two more years. Then in 2017 PSA started increasing at an accelerating rate. Doubling time dropped from about 9 months to barely over 2 months in less than a year. If I had stopped testing at age 70 or so I'd not have known I needed further treatment until I had noticeable SEs.

Jim