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Frequency of PSA testing after RP

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Posted 6/11/2024 4:01 AM (GMT 0)
Hello, I've been lurking around here since I had my RP in November 2022. Quick history - 51 y/o at diagnosis and had RP in Nov. 2022. Pre-op PSA was 4.7. Pre-op and post-op gleason scores were the same @ 3+4 = 7. Negative Margins, Negative EPE, Negative SVI, Negative LN. PT2NO. The tumor volume was 20% of the prostate and the percent of pattern 4 was 5% of the tumor volume. All PSA's since my RP have been <0.01. I had a follow up appointment today and was told that I only need to have a PSA check on an annual basis now. For those of you that have had an RP, did your doctor move you to annual PSA checks after 18 months? What is the standard following an RP without any "adverse" findings? Thanks

Post Edited (Joinedtheclub) : 6/10/2024 8:04:53 PM (GMT-8)

Posted 6/11/2024 6:16 AM (GMT 0)
18 months might have been sooner than what I did... But knowing what I know now - it wouldn't make any difference since my numbers didn't change.

As a compromise, you can go every six months and let them draw the blood and send it in to be tested.... And save yourself a trip by having the URO's office phone the results.
Posted 6/11/2024 8:41 AM (GMT 0)
Every doctor is different, and it likely depends on you post surgery pathology. My information is similar to yours, and the variation, to me, is about the Dr.

I had my surgery in February, 2015. My first post-op PSA was at 6 weeks, to confirm the trend, and then (working from memory) My schedule was 3 months for the first year, then 6 months, so August 2016. In the fall of 2016 I moved across the country and started seeing a different Urologist, who told me HIS policy, regardless of final pathology was every 6 months for 5 years, then annually.

After the 5 year mark, I transitioned to having my PSA as part of my annual blood work from my PCP, and I no longer see a Urologist, and don't intend to unless I have new issues.
Posted 6/11/2024 1:47 PM (GMT 0)
JTC - The standard handout from my URO practice in 2018 was first 2 years @ 3 month interval, next 3 years @ 6 month interval, annually after 5 years. At the 5 year point, my URO said it was my choice to stay at 6 month or annual, whatever I was comfortable with.

I do know some men who did at surgery at Mayo-Rochester in recent years and they are pushing the testing schedule along faster like 3 month testing for 1 year, 6 month testing after that, and not sure on the annual testing. I do know that my URO always talked of testing anxiety being a real concern and Mayo shares that belief also.

I think the one year at 3 months and 6 month testing after that is fine. The first two years tends to tell the tale for most men after surgery as that is when early recurrence will be evident, after that it is more the luck of the draw where only the cancer knows if and when it might attack again.
Posted 6/11/2024 10:36 PM (GMT 0)
I was every 3 months the first year, then every 6 months. at 24 months, I was told if my PSA came back undetectable again, which is what they fully expected, I would graduate to yearly testing. However, at 2 years I lost the "<" sign. So back to 3 months
Posted 6/12/2024 12:14 AM (GMT 0)
Diagnosed in 2013, and trying some new medications and treatments, my oncologist and I met every four weeks for the past decade.

Each visit included a trip to the lab.

With this regimen, I have had over 100 PSA tests. Each case is different, and this regimen suited my case, being diagnosed with prostate cancer that had already infiltrated both lungs, at the time of my diagnosis.

In recent months, I requested a less rigorous appointment schedule. I now see my oncologist every five weeks, and have my PSA assessed every ten weeks.

All of this may seem overzealous, but the impact of new approaches and treatments was being monitored and tracked. This included being treated with upfront chemotherapy, three different forms of ADT injections, a course of radiation mapped out by Mayo Clinic, and starting ZYTIGA, when it was relatively new.

My treatment data has been entered into a vast medical database at Mayo Clinic, with my permission.

My best to all ~ stay determined in the battle!
CYCLONE ~ # Iowa State University
Posted 6/12/2024 7:11 AM (GMT 0)
If your doctor says annual tests are frequent enough, I'd probably trust that advice. A lot depends on your level of anxiety. Some people get nervous with long intervals between testing, and when that's true, more frequent tests make sense.
Posted 6/13/2024 5:06 AM (GMT 0)
Thanks for the replies. It seems a little soon to be on an annual basis at this point, I think I'm going to request to stay at every 6 months for now.
Posted 6/13/2024 8:48 AM (GMT 0)
This paper may help. I hope it can still be downloaded free of charge,
"Establishment of the Optimal Follow-up Schedule..." K. Matsumoto et al.
Urology Oncology. Seminars and Original Investigations 36 (2018) 341e9-341e14.
It describes results from a not very large sample of Japanese patients and employs the criterion of PSA>0.4 to sign a clear recurrence which I guess many people will find too weak.
In summary, it recommends relaxing to annual tests to those whose psa does not exceed 0.02. Again, I guess many here will disagree,
The most interesting part for me is a detailed Figure showing BR probability intervals that depend on current psa and time from surgery.
Posted 6/13/2024 10:22 AM (GMT 0)

jmadrid said...
In summary, it recommends relaxing to annual tests to those whose psa does not exceed 0.02

Interesting article. Thanks.

From what I could see, perhaps that should read .2 instead of .02?

Robert
Posted 6/13/2024 11:49 AM (GMT 0)
As you can see from my data below, my situation, except for age, was very similar to yours. My uro had me doing annual with her for just a couple years and then turned me over to my PCP. I just had my annual and my PSA was undetectable. Except for dealing with the AUS and its replacement, all this is sort of behind me.
Posted 6/13/2024 12:54 PM (GMT 0)
Like Halbert, somewhere around the 5 years with the < sign I didn't need to go to my uro anymore so I get PSA included annually when I have my labs with my GP. If anything changes I'll deal with it as things come up.
I'm not sure there is a standard. Different doc's different thoughts.
Keep the <'s coming,
Noggin
Posted 6/13/2024 3:25 PM (GMT 0)
Not sure if it equates but after SBRT I am tested every six months.
Been over two years.
Now 0.9 was around 3.75

Glen
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