PSA rise from 0.02 to 0.04 in 7 months

The usual definition of recurrence after RP is PSA hitting 0.2 or 3 consecutive increases above 0.1. However, some centres are not waiting that long anymore before initiating further investigation or treatment, particularly if the post-prostatectomy histology showed positive margins or if the cancer was aggressive. You haven't given your diagnosis or histology.

The general choice of actions is

1) To wait until the PSA rises to 0.2 or 0.5 and have a PET scan to try and find it, and then treat it and the prostate bed.

2) To assume it's in the prostate bed (which it most commonly is) and treat that with salvage radiotherapy.

Hessa, if you have a look in my profile you will see my PSA fluctuated after RARP, although overall the trend was upwards, my post op histology was not good. 

Just clarify your results are 0.02 and 0.04 and not 0.2 & 0.4.  Many  say undetectable is below 0.1, what were your post op values 

A PSA of 0.2 used to be the trigger value for additional treatment. Our hospital will now PSMA scan at 0.3, even at higher levels they are not totally reliable.

Thanks Chris 

Edited by member 25 Jun 2023 at 11:04  | Reason: Spelling

Hi,   

You don't say what undetectable is at your hospital as it can vary from 0.01 to 0.1.   I guess it's 0.01.    You could think that if some people don't know it's changing until it reaches 0.1 then your psa is still low and you could watch it and wait a bit longer.

Although some hospitals intervene earlier than others for reasons said by Andy above or if it's increasing fast.  Yours is increasing moderately.   Mine increased fairly quickly but then slowed a lot.  Mine was five years after the operation.  As yours is fairly soon after the op they might be looking to treat it earlier.

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After you ask what they're planning to do you could ask if they're planning to do any scans. Your psa is very low for a scan to find anything.  You might ask at what level they'll offer you a psma scan.  Some hospitals like mine wait until 0.5 others as said above say 0.3.

You could check if they're offering hormones and radiotherapy or just radiotherapy.  How long the hormone treatment will last and if it's before and after radiotherapy.

You could also see if the consultant is one who's willing to do more radiotherapy on other areas if the initial one doesn't get it all.

On alternative treatments when you've had surgery there isn't much other than radiotherapy, as far as I'm aware, unless it can be seen on a scan as being somewhere else in the body than where the prostate was.

You're right to worry about your continence as radiotherapy before it's fully recovered can make it worse, although I don't know much about that. 

Good luck it's always difficult knowing if to let the hospital use radiotherapy without scans or to wait for a scan, especially if the Oncologist is insistent. 

Regards Peter