PSA still OK, but perhaps edging upward

I had my 6-month uro visit yesterday with the usual blood draw for my uPSA test. My last two readings were 0.038 followed by 0.036 three months ago. I told my uro that if my latest came back greater than 0.040, I'd like to retest in 3 months. I just got the results: 0.049.

The long-term plan as of now is to do nothing unless I reach about 0.2 and there is some likelihood that a PSMA scan would reveal the location of any PCa lesions. My uro/surgeon had absolutely no problem freeing up my prostate during surgery, my path staging was pT2, all 16 lymph nodes removed were negative, and my Decipher test was low risk for mets. If I should encounter BCR, I'm not going to rush to irradiate the prostate fossa/pelvis indiscriminately not knowing whether the recurrence is located there or in mets who knows where.

If, after this many years a recurrence is truly limited to the pelvis, then there is a good chance it will remain there long enough for it to reveal itself on imaging. On the other hand, if distant micromets have already formed outside the pelvis, then local RT won't address them (and there might even be nothing in the pelvis). In that case also we would need to know the location to determine the best treatment.

At least that's my current thinking. My uro/surgeon isn't concerned with my PSA values. If I had been using his in-office PSA test up to now, I'd still probably be (just) below its detection limit of 0.05, "undetectable," and none the wiser.....yet.
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9-16-17, 5 weeks post-RP) PSA <0.1, all subsequent test done with Labcorp's uPSA:

(3 m ) 0.010
(6 m ) 0.009
(9 m ) 0.007 (nadir)
(1 yr.) 0.018 (?)
(13 m) 0.013 (retest)
(15 m) 0.012
(18 m) 0.015
(21 m) 0.015
(2 yr.) 0.016
(28 m) 0.015
(34 m) <0.014
(40 m) 0.037 (?)
(43 m) 0.020
(46 m) 0.018
(52 m) 0.023
(5 yr) 0.038
(63 m) 0.036
(5 yr 6 m) 0.049

Djin

mattam said...
In the past I think some guys would be saying you need to be doing SRT ASAP. The PSMA scans seem to be shaking things up for the better. Your situation is a good example. Sounds like a good plan.

The confounding issues are that not everyone with an increasing PSA continues to rise to 0.2 (that is one reason Johns Hopkins originally proposed 0.4 as the definition of BCR back when it was being decided by the medical community). In addition, not all men with BCR go on to clinical recurrence (even if the prudent thing is usually to treat).

Djin

Post Edited (DjinTonic) : 2/3/2023 10:30:16 AM (GMT-8)

Djin, sounds like you've got a good well thought out plan, especially in view of the low Decipher score. (why am i not surprised LOL)
This is not a trend thats been established coming after, .038, then .036, so no need to be concerned at this point.

I'll call the two approaches "Chicken Little" (the sky is falling, head for RT machine in the hills) and "Alfred E. Neuman" (What, Me Worry?).

Discussing PSA anxiety with my uro yesterday, he said it is a recognized phenomenon among urologists, usually starting about a week before one's test and lasting until the result is back. I told him I was some kind of reverse exception: I get antsy not knowing what my current PSA is and, strange as it must sound, look forward to my PSA test.

Djin

Post Edited (DjinTonic) : 2/3/2023 6:45:48 PM (GMT-8)

Djin - Only anxiety I have anymore is waiting for the results. It is a theoretical problem until they take the blood. Nice that all results are turned over quickly now, was not always that way.

Thanks to all for the kind words.

Djin