Whelp... The result was 0.2ng/mL.

Any unexpected rise in PSA warrants a retest--you don't have to wait three months--perhaps one month is enough time to rule out lab error (and perhaps return to your previous level) or even see a rise if, on the other hand, your PSA is climbing fast.

You might want to switch to an ultrasensitive PSA test. The right-most digit of a lab test has the most uncertainty, especially if your result has only one non-zero digit and if you are testing near the lower limit of your assay. You also have rounding and test-sensitivity issues. I suggest Labcorp's 3-decimal ("ultrasensitive") or Quest's two decimal ("post-prostatectomy") PSA test.

If your PSA is indeed rising, an ultrasensitive test will let you monitor it better and calculate your rate of rise (doubling time) much more accurately.

Djin

Patrick, sorry you are going through this. What was your post-surgery pathology. I would also re-test pretty soon (why not tomorrow) to get it done. If you are at .2, you want to speak with a radiation oncologist.

Do you still have access to your pathology specimen? If so, perhaps ordering a Decipher test (genomic classifier test) would be instructive on any additional treatments going forward....

Get the needed info and then stay off the computer and get outside and breathe and enjoy.

Building up a bit more data, at this point, is a wise step.

Visiting the lab next month ~ rather than waiting 3 months ~ gives you two data points, instead of one.

Waiting 3 months means you won't have another data point until almost Thanksgiving time.

My oncologist has taught me that there can be fluctuations.

Our doctors need data, so they can differentiate between fluctuations and true trends.

I have visited the lab every month, since diagnosis in 2013. Each case is different, but my case called for this. I'm still here, and that's due in large part to my medical team's vigilance.

If you wait three months, it's going to on your mind every day, anyway.

A retest is a proactive and timely step. That way, IF further intervention is needed, your medical team can lead you forward.

Wanting all the best for you! Keep us apprised!

We're here to support you and encourage you!

Stay proactive ~ stay vigilant!

With my best, sent to you ~
CYCLONE ~ # Iowa State University

Great to hear, Pat!

You have everything to gain by seeking out a re-test.

One thing I try to remember, for myself:

"Don't cross any bridges, until you get to the river."

You're taking a timely and proactive step. I always sleep better, when I KNOW that I am doing "all I can." You will now have this assurance.

Above all else, remember that the treatment arsenal ~ IF further treatment is ever warranted ~ has greatly expanded since you and I were both initially diagnosed in the same time frame in 2013.

Do let us know how you're faring ~ everyone here is sending positive thoughts and wishes your way ~ and support, understand, and encouragement are the hallmarks of this forum.

We'll leave the front porch light on for you ~ for your next visit!

In fellowship, from one compadre to another ~

CYCLONE ~ # Iowa State University

Next step will probably be some scanning, perhaps the latest PET/Pylarify method that is showing good results finding tumors at low PSA expression. If scans clarify a local recurrence in the prostate bed, then SRT can be successful. If whatever cancer exists is more widespread then the curative probability declines. Time to start fishing.

Pat - 0.20 is about the lowest level that the newer PSMA PET scans might start showing something so you can start having those discussions with your doctors now. The higher PSA the better for scanning but their sensitivity is much lower than previous scanning methods.

There are some other current threads discussing similar recurrence to yours so you might find some helpful information there.

He mentioned he had a focally positive margin at the bladder neck so that’s not a bad thing now right? It could be originating there in which case you could potentially curatively treat that and knock it out. I know if there’s no positive margins and you get a recurrence it’s a greater likelihood it’s spread further out.

@Stephan S, the pathology report showed G6 only, pathalogic stage was P2C, PN0

@Erichardson234, correct, the wording on the pathology report is "The tumor cells are focally transected at the bladder neck margin" After the surgery we did a review of the pathology report with the surgeon. He mentioned he wasn't too concerned about the margin there as he used cautery there and expected that the cells at the bladder neck were burned

My last 4 PSA tests go like this

08/20 = 0.1
08/21 = 0.1
08/22 = 0.2
08/22 = 0.2

I have a follow up with my primary care Dr this Friday and that will open the door to the next steps.

Thanks for the support

I'm with Kaiser and they asked me to retest a few months out, I just got the results back... Another 0.2

8/9/20 8/29/21 8/28/22 11/20/22
0.1 0.1 0.2 0.2

There was a precision test done on 08/14 that was also at 0.2

I've received a referral back to the urologist and I assume my next steps are referrals to a radiation and medical oncologist.

Let the fun begin

Ohh, I'd better modify my signature

Pat

I know what I’d do if it were me.

I’d try another lab.

Dr Notes...
 
Hx of robotic assisted laparoscopic prostatectomy in 2013
Had a positive margin at the bladder neck
 
ASSESSMENT: psa rise 9 years post prostatectomy.had a positive margin. Psa doubling is greater than 2 years.
 
PLAN: continue with q 3 month psa
Also discussed ct and bone scan as well as possible radiation to the bladder neck where he had the positive margin.

Hi.

Yes, time for next steps.

I would suggest a
1. immediate consult with a radiation oncologist...the time for your urologist has now passed, time to look beyond him for now.
2. Sending pathology slides to Dr. Epstein at JHU, just for a little peace of mind
3. Getting a decipher test (which may impact treatment - specifically use of any ADT with salvage radiation - see, Feng et al article.

It may very well be indolent disease remaining (and I very much hope that is the case), but there are ways to fill in the info gaps.

Best,