Rising uPSA

Hello to all and thank you for the wealth of knowledge shared on this forum.

5 years post RP, my uPSA appears to be rising from <.006 initially to .010, then .014 in 8/22 and .024 in 3/23. I realize it is still extremely low to be so far out from surgery and perhaps I shouldn’t even be using the Ultrasensitive. However, when originally diagnosed, I jumped at the first treatment proposed and failed to take time for due diligence. If or when there is a recurrence, I want to have plenty of time to research options, find the right doctor, clinic, etc.

Of course I know that it is too soon to do anything but I would like to hear your thoughts. If the uPSA trend continues, at what point should I contact a doctor. I no longer see a urologist and am self testing through Lab Corp.

Thanks so much!

Hi PB,

I've found that with Labcorp's uPSA test, it has taken me quite a number of data points to get an idea of where I'm going and how fast, especially given my fluctuations. After surgery I was G9 (4+5) with no adverse findings and a low-risk Decipher score. My nadir was 0.007 at nine months post-op and now, at 5.5 years, I have risen to 0.049.

Your PSA may stabilize rather than increase. Doubling time is one factor to consider; however, doubling time at very low PSA values isn't reliable from what I've read given the fluctuation and "noise" inherent in uPSA testing. I will use my approx. doubling time (0.040 to 0.080) as an indicator if I reach 0.080. My uro/surgeon isn't concerned yet, but I have chosen to go back to testing every 3 months (I had gone to every 6 for a time).

I chose to monitor my PSA with Labcorp's uPSA test. My uro's joint practice uses an in-office Labcorp PSA test that goes down only to <0.05. I had been using that test, I would still be "undetectable" and non the wiser.

BTW, if you have health insurance, I am fairly certain they would cover uPSA testing if ordered by an MD, given your high-risk status after surgery--BCBS covers mine..

If you haven't already seen the Forum thread on it, I recommend this recent paper:

The natural history of a delayed detectable PSA after radical prostatectomy (2023, Full Text)

Djin

Hi Mumbo,

“I do not think there is a massive consensus of when to start early SRT but it is clearly lower than the classical 0.20 definition of recurrence and is beneficial based on most recent studies.”

I agree .20 seems too high and I would probably be more comfortable between .08 and .1. It will take a little time to research doctors and get established as a patient so I may begin that process around .05.

Thanks for taking your time to respond!

Hi F8,

Based on biopsy, I was a G8 but after surgery it was downgraded to G7 (4+3). Epstein reviewed the surgical pathology and noted that 80% of the tumor was pattern 4. So technically a G7 but, if I think of it as G8, I am more prone to be alert and test regularly.

Thank you for replying and I agree, no such thing as too soon. Confirmation point might be a little tricky though.

Take care.

Plate Blocker said...
Hi F8,

Based on biopsy, I was a G8 but after surgery it was downgraded to G7 (4+3). Epstein reviewed the surgical pathology and noted that 80% of the tumor was pattern 4. So technically a G7 but, if I think of it as G8, I am more prone to be alert and test regularly.

Thank you for replying and I agree, no such thing as too soon. Confirmation point might be a little tricky though.

Take care.

"If my urologist were still ordering the standard test, I might be lulled into a false sense of security. I do better with uPSA, keeping me on my toes."

reading your responses it sounds like you are being proactive and you understand your situation. good luck to you man!