Posted 9/27/2020 1:59 PM (GMT -5)
Hi kwoo64,
It does appear that may be headed toward BCR. I don't think free PSA plays much, if any, role after a RP (I haven't seen any other Forum members whose docs test for it after surgery and I see just one very old study -- there have been studies of the usefulness of free PSA after primary RT, however). More important, as you know, are factors such as absolute (total) value, rate of rise (doubling time), time after RP that the rise started. Since you were a pT3a, I assume they found extraprostatic extension of your cancer, although you don't mention this in your signature.
Of course you and your docs will decide if and when to start RT, but I think anywhere between 0.1 and 0.2 is good and is considered very early salvage RT. You do want to make sure your PSA isn't going to plateau near its current value, but personally, I don't see why a PSA would be very low and constant for so many years after surgery and then begin to rise, other than biochemical recurrence.
Advanced imaging to help identify the location of the source(s), such as 68ga-PSMA-PET, requires a higher PSA to be of much use. In addition to an indication of mets outside the pelvis, such a scan could help decide if the SRT should be fossa-only or whole-pelvis, but you likely don't want to wait that long. However, a scan just might possibly be useful by the time you opt to start RT -- another topic you may want to discuss with your docs.
As you probably know, many men who encounter biochemical recurrence (BCR) do not go on to clinical recurrence (lesions detectable on imaging), and it takes an average of about 5 years if you do. But you are still young, and I think most men don't want to run the risk and opt for SRT at some PSA point. This is, of course, overtreatment for many men, but, at least today, we can't predict who will and will not progress, and few want to run the risk of going untreated.
My uro told me what I think is generally considered to be true: the longer after RP that BCR begins, and the slower the PSA rise, the better the prognosis.
Keep us posted, please, and all the best!
Djin