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Salvage treatment at 0.07 psa post prostatectomy

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User

Posted 11 Aug 2025 at 08:56

Hi. I has robotic prostatectomy March 24, with initial undetectable psa in May 24. Slow rise to 0.07 in July 25. Referral from Urologist to Oncologist who has recommended Salvage radiotherapy + adt. 6moths. Has anyone experienced similar treatment plan with relatively low psa. Gleeson 4/3 ,Negative Margins, EPE.

User

Posted 12 Aug 2025 at 05:12

Hello mate.

I see you asked a similar question on another conversation and only got one response.

I've done some research on elevated ultra- sensitive PSA levels following prostatectomy to try and answer your query. I'm pretty sure I've read somewhere that PSA doubling times are very significant but that they are not as relevant when dealing with ultra-sensitive readings, but I might be wrong.

I always thought that 0.2 or three consecutive rises below that indicated BCR and possible need for salvage treatment.

I don't feel qualified to comment on considering further treatment at the very low level of 0.07. However, I assume your oncologist knows what he's doing.

I'm mainly responding to let you know that you're not being ignored, and bumping the thread in case others more knowledgeable than me can help.

You say that your first post op was undetectable then there has been a steady rise to 0.07. Can you give the dates and PSA levels of these checks?

Edited by member 12 Aug 2025 at 05:28 | Reason: Additional text

User

Posted 12 Aug 2025 at 07:57

Hallo and Thanks for reply. Dates of psa were. May 24, <0.03, November 24, 0.03, April 25, 0.05, July 25, 0.07. Thanks again.

User

Posted 12 Aug 2025 at 10:21

It seems very early to be deciding to give RT and HT but it can be much more nuanced than just considering PSA figures. Certainly some Oncologists favour early RT to the Prostate bed where statistically further cancer most often develops. The way your PSA is increasing may support this view in your case. Other Oncologists want to leave it until there is a strong possibility that a PSMA scan may show mets elsewhere and then treat with RT what is found. As Adrian implies, your Oncologist is in the best position to decide in your individual case.

Barry

User

Posted 12 Aug 2025 at 10:59

Thank you. There is a degree of uncertainty regarding srt. Have to trust the experts I suppose.

User

Posted 12 Aug 2025 at 17:52

Your oncologist will hopefully be an expert and will also know all the details of your case so, as you say, you are very much in their hands.

This is admittedly an area (i.e. rising PSA after initial treatment) where even the experts do have a range of views and where there is some debate about the best strategy.

As we discussed on another thread, Doctors Scholz and Kwon (both in the USA) tend to favour waiting until a scan (usually PSMA) has pinpointed exactly where the recurrence is. Dr Scholz acknowledges that this not a risk-free approach.

On the other hand the guidance from the European Urology Association currently divides recurrences after prostatectomy into two groups - for men with either a Gleason score of 8+ OR a PSA doubling time of less than about a year, they favour early salvage radiotherapy. For other men they favour a wait and see approach. So it may be, as Barry has said, that your PSA doubling time is the key factor pushing your oncologist in the direction of salvage radiation (though I must say my impression is in line with Adrian's, i.e. that doubling times calculated at PSA levels below 0.1 have been found to be less accurate than those calculated at higher levels).

Best wishes

Kevin

User

Posted 12 Aug 2025 at 23:34

I was referred to Oncology at 0.11. They offered RT immediately or wait. It was doubling in 3yrs so very slow. I opted to wait and they said if it carries on at that rate it's likely I'll die of something else.

I'm on watch for another session with the Oncologist at 0.2. I was offered a psma test when it gets probably above 0.2. Fitting it in timely and hoping it doesn't turn for the worst are things that concern me.

At your doubling rate, which is around 6 months, it will be better to be ready and on the waiting list. I don't know how long you'll wait for RT or how stable your doubling rate will be. Or if you could fit in a psma scan at a higher psa.

All the best.

User

Posted 13 Aug 2025 at 08:19

Hi Peter,

Thank you for your reply. I understand doubling time is a key factor here and it does appear that earlier intervention is more appropriate in my case. So that is what awaits me in the short term. I still feel that my psa rise is better judged if and when it gets in to higher values. Good luck with your monitoring and I hope it remains slow and lazy. Regards, Frank

User

Posted 13 Aug 2025 at 17:42

Hi Hanoi,

I'm on similar timescales to you. RP April 2024 psa undetectable until 6 months ago but its been stable at 0.2 for 5 months. PSMA PET scan three weeks ago. Met consultant for results today and she was surprised that the scan hadn't identified where the cancer was as she said it usually does at 0.2, as scans have improved so much recently.

She's given me the option of 20 sessions of RT to prostate bed as an educated guess that's where it is or just monitor it for a while to see any increase. She said HT wouldn't be necessary at this stage. She said there's no rush to decide as I'm waiting a knee replacement and get that done and see her again in 3 months. It's a difficult decision knowing the after effects that RT could bring.

Your PSA seems really low to be considering further treatment, although my health board only records to one decimal place so I could never have seen the detail you are getting in your results. So didn't know of a psa rise until it hit 0.1. I hope you manage to get things sorted, I'm not sure there's a right of wrong answer to any of it.

User

Posted 13 Aug 2025 at 20:10

Frank, have a look at my profile all my PSA readings are near the start of the profile,so no need to read the whole thing. I had positive margins and EPE.Your medical team may be influenced by the EPE. We are different so comparing stats isn't always relevant. What my long term historical data shows is that the cancer had already left the prostate bed before SRT. In hindsight I was having prostate problems 13 years before diagnosis and my GP missed a PSA of 6.9 3 years before diagnosis.

As regards PSMA scans I was refused a scan in 2017, which may have seen something outside the bed. A scan a 1.4 did not show anything yet a few months later at 3.1 there was multiple spread.

Thanks Chris

My take on undetectable and BCR. Imagine I see a spot of water on the floor, I put a bucket there and it starts to fill up, it's not on the floor yet so is it undetectable. When the bucket overflows and starts to cover the floor do I then conclude the roof is leaking.

User

Posted 13 Aug 2025 at 22:42

Hi there, There is no single answer. The use of ultra sensitive psa has changed the approach..Perhaps your stats are .ore favourable than mine I really appreciate the correspondence

Frank

User

Posted 13 Aug 2025 at 22:50

Hi Chris. Thanks for the advice and observations. So useful to communicate with people who understand the challenges we face. Frank

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