How often should PSA test 5 years after surgery

I was forced to change labs because of insurance and was told after 5 years of undetectable readings that I only have to have PSA test every 2 years. Does that sound right

Happy! But concerned lol

That could depend on the Gleason score from your surgery pathology report. A Gleason 6 might warrant a bi-annual PSA. Personally, I would want an annual PSA test at a minimum.

Here's an article on this very topic, on the Johns Hopkins website, so it's likely pretty authoritative.

It's entitled, appropriately,

"When Can PSA Testing Be Stopped After Prostatectomy?"

and states:

"... men with low-grade disease could reasonably stop testing if their PSA levels remained undetectable for 10 years."

But for men with "... intermediate or high-risk disease" the data suggest "... there remains no standard practice regarding when PSA testing can be stopped for these men who have an undetectable PSA level over longer periods of time, says Patrick C. Walsh, M.D."

and

“We found that the majority of men who had detectable PSA developed it within two years of their radical prostatectomy, and the likelihood decreased every five years."

The gist of the article is that the longer one goes without a PSA rise, the safer it is to drop testing altogether.

https://www.hopkinsmedicine.org/brady-urology-institute/patient-information/books-publications/articles/when-can-psa-testing-be-stopped-after-prostatectomy

Researching on this matter, I found very interesting the paper by Matsumoto et al. "Establishment of the optimal follow-up schedule after radical prostatectomy". I hope you can access. It tries to fix a criterion to avoid a big jump in psa in the next test. It also contains good data of the "minumum" psa doubling time one can expect based in time from surgery and current psa.
I just copy the doi reference, not skillful creating links:
https://doi.org/10.1016/j.urolonc.2018.04.003
Given these data and common sense I would say that one year between tests would be reasonable. My surgeon wants a test every six months between years one and seven. I would be very happy if I have to decide after 5 years. It is still a long and dangerous way to go for me.

My doctor’s post-op PSA practice assuming no issues:
0-2 yrs - 3 mos
2-5 yrs - 6 mos
5+ years - annual
I agree with annual testing at physicals like Tudpock said once the Uro is tired of doing them.

I was curious the cost of a psa test (without insurance) ?

Thanks F8.

In John's boots, I'd probably get the test 6 monthly. Only because if there is a change I might see a trend a bit faster. The downside to 6 monthly is you think about it a bit more (I would anyway).

jasperx10 said...
Thanks F8.

In John's boots, I'd probably get the test 6 monthly. Only because if there is a change I might see a trend a bit faster. The downside to 6 monthly is you think about it a bit more (I would anyway).

you're welcome. that gets better as each year passes. it used to really weigh on me especially since my PSA was a rollercoaster for the first few years. the last year I had no anxiety and also no desire to test more frequently. I think once you're 40 you should check the PSA box on annual blood work for the duration. why wouldn't you?

Is this about the anxiety that testing causes, or the cost? Being just under three years out since RALP, I get tested every 4-5 months. Will probably more to every 6 after a 5 year anniversary. The testing I do, at Quest for the high sensitivity PSA costs me about 6.50$ all in and costs my insurance company about $25, so for that amount of money I think we’re both served having it done 2-3 times a year.