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increased slowly PSA and recurrence.

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Posted 1/14/2025 4:05 AM (GMT -5)
Good morning. I see that my PSA increased slowly over 4 years and some since the operation. I am concerned about what they say about waiting, at least until 0.2 and that if it is in the prostate bed it could be spreading malignant cells throughout the body and over time it may metastasize. how do you see it? On the other hand, it is also foolish to radiate something that does not need radiation and may just be something residual that will not go further. Sorry for my English written with a translator
Posted 1/14/2025 7:48 AM (GMT -5)
Hello - It is difficult to compare medical treatment issues between the US and other countries. The doctors have access to all the same studies but have to work within their medical systems.

In the US, a radiation oncologist (RO) that believes you should have really early treatment for slow rising PSA has to convince the insurance companies or government insurance who help pay for medical costs that the radiation procedure is “medically necessary”. Sometimes, this means a big fight that many doctors do not want to have. Others will fight for the patient and convince them that it is good medical decision. There are too many studies that provide justification for treating and not treating at this time with more recent studies suggesting waiting in your situation.

Only the RO can make the argument for treating you. If the RO does not want to treat at this time, you have to find another RO to get a second opinion that may be the same or may support treatment now. Then the RO has to make sure that the proposed treatment is acceptable to those who pay him/her which is where the problems start, at least in the US.

Radiation treatment is quite expensive in US so it is beyond most people to pay cash for treatments but that option always exists for those with lots of extra money.
Posted 1/14/2025 9:49 AM (GMT -5)
why is my signature not appearing?
Thanks
Posted 1/14/2025 9:52 AM (GMT -5)
In Spain we have a public health system. But you haven't answered my thought.
Posted 1/14/2025 10:29 AM (GMT -5)
Don't know about signature issue - check your profile to make sure signature is still there, make a small change and re-save. Log out and log back in again, clear cache on web browser would be my first steps.

My situation in 2018 was clear (to me) to pursue adjuvant radiation (ART - radiation with non detectable PSA < 0.10). Both the urologist and radiation oncologist told me that it was my choice and they could support either decision. This was with a pathology that was much worse than yours and should have resulted in a clear recommendation for ART (to me).

Your summation is exactly what the issue is, no best choice. However, more current studies seem to point to there being virtually no improvement in recurrence probability with eSRT at PSA levels lower than 0.20 unless there are additional risk factors. Even the difference between ART vs. eSRT is not shown to be that much from what I have read so the studies continue on.

The risk of treating men who do not need it sometimes outweighs the logic of treating everyone no matter what the situation is. You understand it as well as anyone.
Posted 1/15/2025 5:17 AM (GMT -5)
Is it a systematic increase using ultrasensitive PSA? Here, some labs like mine give non-ultrasensitive PSA "raw" figure without considering the detection limit. I have had so far fluctuations up and down 0.04, always below 0.1, that have scared me before being aware that they were instrumental noise.
Urologists generally think that there is not need to radiate before the limit 0.2 is reached while radiologist claim that it should be done at lower values, some even say at 0.03. Probably, this discrepancy is due to a mix of scientific and economic motivations. I have learned here that nowadays salvage radiation does not imply major secondary effects with about a 50% chance of cure depending of particular cases.
Posted 1/15/2025 4:59 PM (GMT -5)
I was advised by 2 well reputed radiation oncologists at major cancer institutions, that treating earlier is better. And I decided to follow their advice, against the wishes of my urologist/surgeon, who told me to wait until PSA reached .2, and then do scans and if nothing showed, then wait until PSA hit .4, 0-(. When I heard, .4 I said no way, and I treated at .08
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