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Slight change in PSA - No Longer Undetectable

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Posted 10/6/2021 4:42 PM (GMT 0)
Looking for some experience and/or knowledge from this group....... smile
I had my PSA Test earlier this week. My PSA had been <0.05 or Undetectable. This test came back 0.06. My prostatectomy was 1.5 yrs ag ('Apr '20).

Doctor recommended to monitor every 3 mths. Here are the questions:
1. Is that a big deal < 0.05 to 0.06?
2. What is reasonable to expect going forward (e.g. it will increase, stay flat)?
3. More likely than not will need hormones and radiation are some point in the next 1-3 yrs due to the PSA level?

Thanks ahead of time for your input.

Fun stuff, never gets old.......
Posted 10/6/2021 5:29 PM (GMT 0)
Dave,
This is one of those situations where it could be a big deal but there isn't enough data. I'm very surprised your doc didn't have you on a more sensitive PSA test, which might have given you an earlier "heads up" if, in fact, there is a problem. But that's all water under the bridge now.

Really, all you can do is monitor the PSA for a trend. Erroneous PSA tests are not unheard of. Try not to get ahead of yourself with possible future treatments.

One step at a time. Yeah, I know, it's easier said than done. Good luck!
Posted 10/6/2021 5:33 PM (GMT 0)
maybe I wasn't clear.... I was being tested every 3 mths post op and then went to 6 mths after a year. This was the 1st 6 mth test. Instead of another 6 mths, he decided to go back to 3 mths. Is that what you meant by more sensitive PSA test....meaning more frequent?
Posted 10/6/2021 6:00 PM (GMT 0)
After surgery many folks are getting PSA tests with lower detection limits of 0.03, 0.02, 0.01 or 0.006. At this point for you it makes no difference.

There are some big name hospitals still using 0.10 as the lower PSA test limit.

My recommendation is do nothing until you are 0.20 and then get a PET scan using on of 3 tracers that work for prostate cancer. You want to know where it is before treating. Hopefully you have one spot they can radiate.

Post Edited (Duck2) : 10/6/2021 12:03:19 PM (GMT-6)

Posted 10/6/2021 6:22 PM (GMT 0)
Dave,
IF you do end up having a steadily increasing PSA, your next course of treatment most likely would be RT, possibly with ADT, as you mentioned. Since your pathology is G9, I feel that your doc was a little lackadaisical allowing you to go to 6 month tests so soon. And a more sensitive PSA test might have allowed earlier establishment of a PSA trend, if there is a trend. Again, at this point it doesn't matter. Your next PSA test, or two, will probably provide the needed information for possible treatment.
Posted 10/6/2021 7:20 PM (GMT 0)
Yes, the prior posts are 'spot on'.
You will need more data to see what is going on.
Hopefully, future PSA test results will stabilize or show a downward trend.
Posted 10/6/2021 8:25 PM (GMT 0)
You indicate in your signature they pulled a couple of positive nodes during the RALP. Did you get any further treatments after your surgery?

lI am a few months ahead of you on this road. Basically one psa test does not a trend make, and even after several (assuming it keeps rising) the powers that be are reluctant to pull the trigger on additional treatments for lack of knowledge as to where the remaining cancer lies (prostate bed? a nearby node, a distant node, a bone).

They often take the liberty of assuming the cancer is in the prostate bed and hit it with radiation, along with a 6 month period of adt, but since you already had nodes that tested positive i would assume they have reason to justify whole pelvic radiation along with like 2 years of adt.
Posted 10/6/2021 8:32 PM (GMT 0)
Dave i was going to take a wild guess and say you are a patient at MSK, then i looked at your signature again and realized it wasnt a wild guess. I am there as well, and they only test to the level of .05, anything below that is shown as <.05, in other words, too low for the equipment to detect. I dont like it, but in my case, since i already had SRT + ADT , they wouldn't do anything anyway till it got considerqbly above .05

At this point, you might as well continue testing there, since it will show any additional rises. However if the next test comes back at <.05, which is possible, then i would suggest you ask for a prescription and take it to Labcorp for the PSA test, they test down to <.006, basically 0, since we usually ignore the last digit. This way, you will be able to detect any rises that have not yet reached .05. They will probably insist on doing their own PSA test, they like everything done in their own lab, so you may have to pay out of pocket but if in fact you get <.05 on your next test, it would be worth the few bucks it would cost you to get a parallel test at Labcorp.

Good luck and keep us posted.
Posted 10/6/2021 8:37 PM (GMT 0)
One more thing, no disrespect meant to Duck and his post above, waiting till .2 is standard based on American Urological Association standards, but i would not wait. If you see a definite rising trend, meaning 2 or maybe 3 increases in a row, i would act. Studies have shown (i no longer have the links but you can google) that the earlier treatment begins for salvage the better chance of cure.

AND, PARTICULARLY WITH A G9, i would not wait until you reached .2 to act.

I Started SRT + 6 months of ADT when my PSA HIT .08. it had been rising for over a year, i was testing at Labcorp at the time, because i didnt start working with MSK until i had detectable PSA.

Please keep us posted.
Posted 10/6/2021 8:39 PM (GMT 0)
Hi dave.

"Is that a big deal < 0.05 to 0.06?"

As has been mentioned, you'll need more data points. The change could be as small as 0.049 to 0.055 or it could be much larger. You don't know (1) how close your previous readings were to 0.05, (2) if you were previously rising or steady, and, (3) if rising, how fast the rate of rise has been.

Since you were G9 (4+5) with positive lymph nodes, it's good that you are monitoring your PSA every three months. (I don't understand why you were changed from 3- to 6-month testing.) You were pT3a; am I correct that your forgot to mention there was also extraprostatic extension documented in your post-op path report? For monitoring purposes I suggest you request your PSA be measured with Labcorp's 3-decimal ultrasensitive test.

Did you decline adjuvant therapy after your path report? I suggest a consult with a R.O to get a plan in place (likely RT + ADT) for salvage therapy, which you may want to reconsider even if your PSA holds steady.

Djin
Posted 10/7/2021 2:51 AM (GMT 0)
"One more thing, no disrespect meant to Duck and his post above, waiting till .2 is standard based on American Urological Association standards, but i would not wait.'

yep you are G9. .2 is late in the game, imo.
Posted 10/7/2021 11:20 AM (GMT 0)
This article makes a powerful case for initiating salvage radiation at the first sign of rising PSA:
https://ascopubs.org/doi/full/10.1200/jco.2016.69.0396
Posted 10/7/2021 12:28 PM (GMT 0)
https://ascopubs.org/doi/full/10.1200/jco.2016.69.0396
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