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PSA testing after prostatectomy

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User

Posted 25 Jan 2024 at 13:03

My understanding was that for the first year following a RP one has PSA tests every three months. I've just received correspondence from the urology dept which states tests to be done every four months.

Does anyone know if the guidelines have been changed, or is this more likely to be a cost saving measure by the Trust (ie three tests per year rather than four)? More pertinently, does an additional month between tests matter?

User

Posted 25 Jan 2024 at 13:18

Thanks. The first PSA test, at six weeks, came back with a <0.01 so it would seem that subsequent tests at four month intervals is fine.

User

Posted 25 Jan 2024 at 14:42

Fed ,NICE did change testing intervals some time ago ,I believe the following is the current guidelines for the UK.

"For people who are being managed with radical treatment: PSA levels should be measured no earlier than 6 weeks after treatment, then at least every 6 months for 2 years, and once a year thereafter."

The document is guidance and the document does say "at least ". The first PSA test and histology results may dictate further test intervals.

Thanks Chris

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User

Posted 25 Jan 2024 at 13:16

The first PSA should be 8 weeks after your RARP - if that is less than 0.01 then you could be on 3,4,or 6 monthly tests and to be honest, neither matter as your PSA needs to get to > 0.2 before any further action will be considered and PSA takes a long time to rise to that from a 0 start.

However, if post RARP is not < then a 3 month PSA is standard but again, making it 4 isn't going to cause you any issues.

Edited by member 25 Jan 2024 at 13:17 | Reason: Not specified

User

Posted 25 Jan 2024 at 13:18

Thanks. The first PSA test, at six weeks, came back with a <0.01 so it would seem that subsequent tests at four month intervals is fine.

User

Posted 25 Jan 2024 at 13:22

Hi,

Just had. RP in December in Germany and confirm here the protocol is quarterly testing.

I would not compromise on it as time is key in the battle of this disease.

User

Posted 25 Jan 2024 at 13:30

Fed

I would disagree with you on that one as PCs is not a fast growing cancer. In fact it is one of the slowest. The most difficult part of PCa is getting that first diagnosis. Because it has no symptoms, men ignore it until it is too late and that results in the need for radical treatment.

User

Posted 25 Jan 2024 at 13:36

Originally Posted by: Online Community Member

However, if post RARP is not < then a 3 month PSA is standard but again, making it 4 isn't going to cause you any issues.

I still need to take the test at 8 weeks, but my urologist already told me that if we go above 0.1 we will consider further treatment without waiting to hit 0.2.

I think it is important to understand, and it is not always easy, what is a cost benefit advice based on statistical evidence vs. the one that is the safest for the patient. Delaying PSA testing of one month brings down costs for the system and in% is probably safe for most of the patients, but what makes me confident that I belong to this majority?

My PSA was always perfect: in March 22 was 1.6 and 18 months later was 5.1.

I will do my tests quarterly and in the doubt will keep them doing if am lucky enough to go without issues through the 2 years. I do not want to give back to the disease even one day of time to work against me.

User

Posted 25 Jan 2024 at 13:44

Originally Posted by: Online Community Member

Fed

I would disagree with you on that one as PCs is not a fast growing cancer. In fact it is one of the slowest. The most difficult part of PCa is getting that first diagnosis. Because it has no symptoms, men ignore it until it is too late and that results in the need for radical treatment.

What you say it is true; in my case I moved from a situation in 2022 and the years before, where all the markers were perfectly ok to a situation, in 2023 where I had a tumor in the TZ with gleason 4+4 upgraded to 4+5, fortunately fully localized (T2 stage), clear margins, etc. etc.

In my case there is substantial evidence that was not slow and and it was very aggressive. So, to me, also psycologically it looks much better to be very precise in the checks and in the doubt do it one more that one less.

User

Posted 25 Jan 2024 at 14:42

Fed ,NICE did change testing intervals some time ago ,I believe the following is the current guidelines for the UK.

"For people who are being managed with radical treatment: PSA levels should be measured no earlier than 6 weeks after treatment, then at least every 6 months for 2 years, and once a year thereafter."

The document is guidance and the document does say "at least ". The first PSA test and histology results may dictate further test intervals.

Thanks Chris

User

Posted 25 Jan 2024 at 14:57

Thanks Chris,

In Germany it is still valid the quarterly protocol for the first 2 years, then the 6 months protocol for year 3 and 4 and from year 5 yearly.

Do you know why NICE changed the testing intervals? What was the given explanation?

Fed

User

Posted 25 Jan 2024 at 15:39

Originally Posted by: Online Community Member

Thanks Chris,
In Germany it is still valid the quarterly protocol for the first 2 years, then the 6 months protocol for year 3 and 4 and from year 5 yearly.
Do you know why NICE changed the testing intervals? What was the given explanation?
Fed

Fed ,if you read the document it appears to say economic issues were not considered.

https://www.nice.org.uk/guidance/ng131/evidence/h-followup-protocols-after-radical-treatment-pdf-6779081781

The above is the document that should contain the reasoning. I can't find a definitive reason.

Thanks Chris

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