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Posted 7/29/2017 3:03 PM (GMT 0)
Hi all. I'm a newbie. I am 26 months past robotic prostatectomy. Post op PSA was 0.02 three months later 0.03 for two years and last check was 0.04. I am aware that's considered undetectable. My Doc says.. " 0.04 is undetectable but it's detectable". Anybody in this situation? we ( me and doc) are not considering any kind of salvage radiation therapy as of now, but of course, you continue to monitor and perhaps at .2 we'll make a decision. OR perhaps it will just jump around under .1 Sorry to blather on , but if anyone has been through this perhaps you can give me some advice. I'm a songwriter and I'd rather think about words and lyrics than the little numbers every three months. Thanks so very much.
Posted 7/29/2017 3:21 PM (GMT 0)
GL, that would be me. Exactly. Except I'm a bit behind you.

I was undetectable , <.02 , until month 24, at which time my PSA came back at .02, without the "<". Retest showed the same result. 5 months later, this past May I was tested at a DIFFERENT LAB (dr changed labs) and it came back at .033.

Uro/surgeon says "still undetectable, we don't do anything until it gets to .1, at which time we'll do imaging, so don't worry." I told him, if it was his PSA, I wouldn't worry. He did have my tumor tissue sent out for the genomic test "Decipher" which came back with a score of w7, low risk for recurrence"

At that point, I decided, THT while I have a huge amount of confidence in my surgeon, he's a surgeon. And even though I knew it was premature , I took it upon myself to get an appointment with an RO at MSKCC (Zelefsky)

He told me "I wouldn't call it probable recurrence just yet, I would call it a POSSIBLE recurrence. Keep following up with your surgeon, he's great, but if you get another couple of rises or a big jump, that establishes a trend, come back and see me. I don't believe in waiting for it to hit .1 or some other magic number/. Once I see a trend, I would say hit it"

He also sent me for an MRI, in his words, "just to have. Baseline"

So guys like you and I are , I guess, in "nowhere land" until we get some clarity.

I would suggest you add a signature to your profile,with your stats. Gleasonsxore, pathology details, PSA history, etc, it will enable others to offer advice with more knowledge about your case...let me rephrase tha...not advice, opinions, since none of us are doctors.
Posted 7/29/2017 3:43 PM (GMT 0)
I am with you in the no mans land waiting for the trend. My PSA was .11 in April and now it's .10 in July so no trend yet.

Post Edited (Howard3569) : 7/29/2017 9:49:30 AM (GMT-6)

Posted 7/29/2017 4:08 PM (GMT 0)
Pratoman/pratoeveryman...everyman wants to be part of the whole...he spends his entire life trying to find the niche in that whole...when he does...he becomes comfortable in a devils bower...the individual man...can never find that niche...and is never quite comfortable...until he realizes...not recognizes...realizes...that in a mysterious and paradoxical way...being the individual man...he becomes a sum greater than the whole...always fraught with doubt...fear...going forward...reeling backwards...reaching...reaching...always reaching the tip of his finger out to touch the finger tip of creation...which is in fact and truth the reflection of creation itself...this side of the veil and how we self realize is but a portent of reality...momentous or calamitous....ther fore choose life...plant the tiny seed of yes within the heart/mind and with unyielding faith and patience...reap the Joy...it never will leave and will always grow...mark it...logo... smhair scool wink
Posted 7/29/2017 4:34 PM (GMT 0)
Assuming you had no adverse pathology, what you want to watch for is this:

• PSA over 0.03 AND
• Two subsequent increases OR
• PSA increase greater than 0.05 per year

If that happens, there are good chances (63%) that your cancer will progress. If it doesn't happen, you are not likely (~5%) to experience any further progression for at least 7 years.

/pcnrv.blogspot.com/2016/08/low-detectable-psa-after-prostatectomy.html

What you don't want to do is wait until your PSA hits 0.2. At that PSA, the chance that your cancer is still curable decreases by half:

/pcnrv.blogspot.com/2016/09/very-early-salvage-radiation-has-up-to.html

If you are sitting on a fence, the Decipher genomic classifier may help you decide. It's expensive (~$4,000) but Medicare/insurance may cover it - check first.
Posted 7/29/2017 4:53 PM (GMT 0)
Wow. Talk about detail and info. Thanks so much for the kind replies.
I will take it all with me to next ORO visit and PSA test.

I will also get my signature from the Doc.

GLH

I don't care if they call me a dumb blonde. I know I'm not dumb. I also know
I'm not blonde. - Dolly Parton
Posted 7/30/2017 7:32 PM (GMT 0)
This recent study Impact of Postoperative Radiotherapy in Men withPersistently Elevated Prostate-specific Antigen After Radical Prostatectomy for Prostate Cancer: A Long-term Survival Analysis
is interesting for those with detectable PSA post surgery. It concludes that:
"Not all PCa patients with PSA persistence after RP have universally poor oncologic outcomes. Increasing PSA levels should be considered as predictors of mortality, exclusively in men with a risk of CSM of >10% defined by pathologic characteristics. Likewise, the benefits of postoperative RT on survival are restricted to those men with adverse pathology, indicating the opportunity for an individualized approach to treatment in these patients."

"...in men with less aggressive disease (ie, organ confined disease and pathologic grade groups 1–3), PSA level did not impact cancer-specific survival. In these cases, PSA persistence might be a proxy of benign prostatic tissue left behind during RP, and the impact of competing causes of death would thereby be more pronounced. Further, these patients did not demonstrate a benefit from postoperative RT..."
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