Thoughts would be appreciated

Received notice late last year that my doctor was leaving UTSA Mays Cancer Center. I have not been in touch with any other individual and have been watching my PSA and am now at the point were action is warranted. Just wondering about all your educated comments for consideration.

01/2022 - < 0.006
07/2022 - < 0.006
01/2023 - 0.009
02/2023 - 0.007
09/2023 - 0.010
03/2024 - 0.040
06/2024 - 0.047
01/2025 - 0.122

At this point it seems a scan should pickup any hotspots. All tests are Lab Corp.

Appreciate your time. Blessings

Hello - Sorry to hear you got a higher PSA on your last test. However, no doctor will recommend doing anything until you get another test or two. Never know if the result is out of line without another test. That being said, it is getting near time to line up an oncologist who is experienced with PCa recurrences to help you going forward.

The current rules seem to be that one has to have a couple of PSA tests over 0.20 to demonstrate recurrence. When one has had both surgery and RT, the treatment options are limited until scans can isolate the problem area(s). Scanning is much improved with the addition of the PSMA PET scans but they are still not very reliable at low PSA but much better than in then past. Your oncologist will want to see where your PSA is going and at what rate to determine when to start scans.

No one really wants to go on lifetime ADT so most efforts will be directed to finding the source of the PSA and zapping it if not widespread and in a treatable location. How high the oncologist will let your PSA go before doing scans is a function of the PSA increases. Some doctors are really aggressive, others will wait until the odds are better that something might be located. More pushback from private insurance vs. Medicare might be expected. Just guessing but 0.25 to 0.50 might be where the first PSMA scan would be done. It is always possible a CT or MRI scan might pickup an enlarged lymph node but the PSMA scan might be more definitive.

You have time to find the right doctor and get some more tests done at a reasonable interval. Technically, you don’t have a problem yet so hang in there until the doctor says it’s time for next steps if and when needed. Good luck.

I got an axumin F18 PET scan when PSA hit 3.0 after surgery, radiation and leuprolide chemo. That showed 3 lymph node mets. I got them cooked, PSA dropped to <0.1 for 3 & 1/2 years, then it began to come back up. At PSA of 0.28 I got a more sensitive gallium 68 PSMA PET scan in early Dec 2024. No results, so I will get a PSA blood test in late Feb this year, then a reevaluation for another PSMA PET scan in early Mar 2025.

My conclusion: PSA of 3.0 is indeed sufficient to get a picture, 0.28 is not. Your mileage may differ.

JMHO, while the last reading was a big enough jump to consider the possibility of it being an outlier, I still think your previous tests are showing a clear trend. I would get a meeting with a radiation oncologist.

I had a similar slow trajectory over 3 years, and was treated at a psa of .08, which I know is early but that was recommended by two highly reputed rad ones, at MSKCC and Cleveland Clinic. Protocol may have changed since then.

5.5 years ago when my PSA was1.17 my URO got me into a F18 Pet scan which showed two small LN in the pre sacral area that were hot. Too small and out of the way for surgery so had pin point RP aimed at LN and general prostate bed. Undetectable since then. I’m with Trailguy, gotta have a target to zap which means the test have to have something to show for the multi million$ RT machines to target.

Dave

FWIW, got yearly bloodwork back and still <.008.Thank you F18 Pet scan, radiation machine and my URO.

Dave

Comments based on my experiences. Watched and waited while my uPSA rose from post RP nadir of 0.051 to 0.113 to do salvage RT to prostate bed; nadir 0.075. Immediately accepted we missed. When it was back up to 0.131 I traveled to Europe for imagining that identified multiple suspicious pelvic lymph nodes. I chose salvage lymph node surgery which confirmed six cancerous nodes including para-aortic. That's six at 0.131.

Today, holding 3.5 years very low stable uPSA 0.03X range, I have annual liquid blood biopsy testing and imaging. My intent since my Dx ten years ago is to, if it comes to it, to defer ADT/CR for as long as possible. I learned to not give this beast time and obscurity. Hope this helps. All the best!