Psa bump 14 years after prostatectomy

I’m sorry but three rises do not equal bcr and there isn’t a dr that will treat until I hit .15. I’m now 15 years out from surgery and the treatment protocol is completely different from someone in the first 5 years. Please don’t offer advise that is ill thought out.

Dalota - don't get too hung up on studies, there are many studies of the various PCa components beginning many years ago that have the longest statistical duration but also do not reflect current understanding, imaging, or treatments, however flawed they may be.

I was "whipsawed " in my thinking many time as my PCa situation developed and someone would post a "did you see this study" and off I went. I would read everything I could find and either toss or save in my PCa folder. Every study has to be carefully studied, source considered, and compared to other studies to see if they are on the same page or describing a somewhat different variation. It is numbing after a while and you eventually need something to push you over the edge and make a decision. Adjuvant radiation treatment was my choke point, there were two camps, to do and to wait. It was a well known doctor telling me that if it was him, he would definitely go ahead with ART which sealed the deal.

So discuss your findings and questions with your doctors, look for that nugget of info that makes sense to you and guides your next steps. You can also sign up on all the PCa forums you can find and attempt to reconcile all the opinions you might get and go crazy as you get farther from a clear solution rather than closer.

From Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part I: Introduction and Treatment Decision-Making at the Time of Suspected Biochemical Recurrence after Radical Prostatectomy Treatment Decision-making at the Time of Suspected BCR after Primary RP (2024)

"Guideline Statements
Treatment Decision-making at the Time of Suspected BCR after Primary RP

1. Clinicians should inform patients that salvage radiation for a detectable prostate-specific antigen (PSA) after RP is more effective when given at lower levels of PSA. (Strong Recommendation; Evidence Level: Grade B)

2. For patients with a detectable PSA after RP in whom salvage RT is being considered, clinicians should provide salvage radiation when the PSA is ≤ 0.5 ng/mL. (Moderate Recommendation; Evidence Level: Grade B)

3. For patients with a detectable PSA after RP who are at high risk for clinical progression, clinicians may offer salvage radiation when PSA values are < 0.2 ng/mL. (Conditional Recommendation; Evidence Level: Grade C)
____________________
Table 1. - High-risk Features in the Setting of BCR to be Considered for Patient Counseling and Management /a/

• Grade Group 4-5
• Stage pT3b-4
• Surgical margin status /b/
• Node-positive disease
• Short PSA doubling time (PSADT)
• Short interval from primary therapy to PSA recurrence (including persistent detectable PSA after prostatectomy)
• Higher post-prostatectomy PSA
• Genomic classifier risk
• PET imaging findings
____________________
/a/ The Panel recognizes that the above does not represent an exhaustive list of relevant prognostic variables.
/b/ Of note, the presence of positive surgical margins has been associated both with an increased likelihood of BCR as well as a lower risk of disease progression after salvage radiation."
_____________________________________________________
[From Part 1 of 3 Parts]

Note how the above Recommendations go from Strong to Moderate to Conditional. We have to keep in mind that for evidence-based medicine, not all the evidence is equally strong.

If you think of each of the parameters in Table 1 as a toggle or slider on some master control panel, the difficulty of decision-making for many men becomes apparent.

While I and my uro are familiar with the factors that will go into any decision for salvage therapy that I may need (Table 1) and the suggested PSA thresholds (above and elsewhere), my uro and I decided it was time to consult with an R.O. to do the hard part: weigh all the factors for my particular case, synthesizing and applying their knowledge of the salvage-therapy literature, their clinical experience, and their institutional results (Duke in my case) to best counsel me.

Mattam- you too are misinterpreting data. I spoke to an RO and he said those situations in which people were treated below .1 are completely different than my situation. Those were for patients that are high risk and when you see rising psa within close proximity to surgery. For someone who has delayed BCR, i.e. greater than 10 years, SRT should be considered between .2 and .5, but preferably when you can see something on a scan and better target. He said if an RO suggests starting BCR for you now, he said run as fast as you can and find another physician. Furthermore, he said you would never get approved by insurance anyways.

Dalota said...

>>> Mattam- you too are misinterpreting data.>>>

Misinterpreting data? What data? I was just verifying an approach described by another member, which I know has been put in use.

>>> I spoke to an RO and he said those situations in which people were treated below .1 are completely different than my situation. Those were for patients that are high risk and when you see rising psa within close proximity to surgery. >>>

Well, if a treatment works for high risk PCa it will almost certainly work for low risk PCa. 🙂

>>> For someone who has delayed BCR, i.e. greater than 10 years, SRT should be considered between .2 and .5, but preferably when you can see something on a scan and better target. >>>

Sounds okay to me but I still feel there may be some risk by waiting to do a PMSA scan, which may or may not tell you something. Also, I have learned the hard way that doctors say a lot of things, and sometimes they are correct. And these PSA cutoff points have always seemed pretty arbitrary to me. If still using “curative intent” treatment, earlier will almost alway be better than later.

If your situation is low risk, I wonder where all your concern is coming from?

In any case, Happy Thanksgiving. No worry for a few days. 🦃

I would advise you to let a doctor you trust guide you, which you seem to be doing. PCa treatment is constantly in flux. Just in the 10 years I’ve been on the Forum great changes have taken place. We members just speak from our research, personal experiences, and reports from other members.

We are not medical experts. So my point here is that it’s in poor form to come on here and tell members in a snippy tone that they are offering ill-thought out advice, or that they are misinterpreting data.