low rising uPSA 0.026 6 years post RP

Hi jronne. (We usually put earlier data above later data, so I read yours backwards at first.)

My uPSA after my RP has been fluctuating from the start, even though my nadir was <0.007.

(3 m post-op ) 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 (3 months ago)

My uro said he was happy waiting 6 months, but I had scheduled a 3-month check for later this morning. Notice my 0.18 dropped to 0.013, and my 0.037 reading dropped to 0.020, and I'm hoping today's drops down as well. However, I might be both fluctuating AND trending up slowly. My uro emphasized that I am quite far from the level where even the newest scans are useful.

In my own situation, I have no reason to think any recurrence would be more likely in my prostate fossa than in metastases. Personally, I wouldn't want to irradiate my prostate bed (as sole treatment) without having a (literal) picture of what's going on and where it's happening: perhaps I'll have nothing in my pelvis and only some distant met(s). On one hand, I had a low-risk Decipher result, but on the other no post-op findings that the cancer wasn't prostate-confined.

Can you give us your post-RP pathology findings? Were there signs of local spread (EPE, positive margins, SVI, bladder-neck invasion)? Did you have Decipher test done to asses met risk? If not, you might consider one now. Your doubling time seems low, and I don't know how accurate/significant it is at these very low values (technically, my PSA more than doubled from 9 months to 12 months after surgery, but who goes for SRT with a PSA of 0.018?).

My uro's practice uses an in-office Labcorp uPSA test that goes down to just <0.05 and I am his only patient using Labcorp's <0.006 test (I have my blood drawn at his office and it's sent out to a local Labcorp facility). Had I been using his practice's lab test, I still would be "undetectable" and none the wiser.

So are you and I both still "undetectable" or are we both in need of SRT now? Are our cases different because of my fluctuations and your new slow rise? If my PSA jumps up again today rather than dropping or holding steady, I'll have another chat with my uro, who will probably repeat that he still isn't concerned. If you do go for an RO consult, please let us know what advice you are given. My hunch is that a RO would send a patient with a PSA of 0.026 on his way.

My PSA 3 months ago was 0.039. Is this just (benign) physiology? Do I have local recurrence and/or metastatic disease? I'm not sure I can have an answer given the state of medicine today. Keep in mind that the official definition of BCR (after surgery) is still 0.2 for a reason and many men with even higher PSA values do not go on to clinical recurrence. And for those who do it may take many years. The problem is knowing (guessing) which category one falls in, and deciding if and when to treat further.

Djin

Randomized Phase II Trial of Salvage Radiotherapy for Prostate Cancer in 4 Weeks v. 2 Weeks (SHORTER)

https://jcto.weill.cornell.edu/open_clinical_trials/randomized-phase-ii-trial-of-salvage-radiotherapy-for-prostate-cancer-in-4-weeks-v-2-weeks-shorter
(Copy & Paste: link doesn't seem to work)

"Clinical Trial Details
The purpose of this study is to compare urinary and bowel side effects of hypofractionated radiotherapy in 20 treatments (4 weeks) to ultra-hypofractionated radiotherapy in 5 treatments (2 weeks) for prostate cancer that has returned after prostatectomy.
...
Standard treatment regimens range from 20-40 treatments."
__________________________________

It appears that clinical trials for hypofractionation are still in Phase II. If I need SRT in the relatively near future, I'll pass on anything that short, especially if I'm told that even at best there would be no oncological advantage--only equivalent results that are more convenient and possibly cheaper to administer. The long-term results of such studies won't be available to help many of us here.

Djin

As you can see from my signature, I had a gradual rise over the years after surgery. I used the traditional PSA target of .20, and I pushed the button at .18. I had IMRT/IGRT on the Calypso machine, 40 treatments over 8 weeks. This was in Mesa, Arizona. This machine uses 3 little transponders about the size of a piece of rice, inserted in the prostate bed for targeting. This was the most painful part of the procedure. Otherwise, the 40 treatments were a piece of cake. Some minor fatigue and constipation that went away a couple weeks after completion. PSA dropped quickly to <.03 and has stayed there for 3 years.
At the time, my RO said no scan would show anything at a PSA level of .18.
Jronne, it appears to me that you are nowhere near the ballpark for SRT. Just keep monitoring.

Jronne,
Similar as you and DjinTonic, I had last year PSA scare. In June 2021, suddenly it was reported as 0.12. It was big surprise for me and my doc. He ordered retest 3 months later and in September 2021 was reported as 0.022 uPSA. Doc still had doubts in correctness of the results. In December 2021, it was back to 0.008. In June of 2022 was 0.012. My next one is in December. Doc is not concerned any more. He said it is just some noise.
I am almost 6 years post RP (11/2/2016). I am not worried either
MK