Calculating PSADT following recurrence

teddyu

Just joined this forum.  I had a robitic prostatectomy 1 year ago.  Gleason of 4+4 determined post surgery.  Inital post-op PSA =.1 ng/ml.   4 months later PSA = .2 ng/ml (recurrence).  I am having PSA determined every two months.  PSA has stayed steady at .2 ng/ml for 5months.  Latest PSA=.3ng/ml.  Number is starting to rise. 

My question is when calculating the PSA DT, do I use the initial .2ng/ml date for calculating DT or the last .2 ng/ml test result date?

I will not see my urologist until after my next  PSA test in January.  I'm not sure of the baseline date.  Depending on the calculation perameters i'm on the cusp of the 10+ month criteria. Using a later date will indicate a more agressive recurrence,  Using the earilist date will probably put me over 10+ months.  Trying to get a handle on the potential treatment paths available to me before I see my urologist.

 

Thanks for any help.    

VascodaGama

Nadir PSA is the reference

PSAdt is calculated starting from PSA nadir. However, the timing of a salvage therapy is not dependent on PSAdt alone. Many other factors with regards to the initial diagnosis process contribute in judging recurrence, in what to do and when to start a salvage therapy. 

AUA recommends intervention when the PSA is 0.4 ng/ml. Typically it recommends salvage radiotherapy (SRT) for those recurring from RP but this is like directing the rays to imaginary targets that may not be the source of the problem. PET scans are now used to identify targets in recurrence cases but these have shown to be more reliable when the PSA is above 0.7 ng/ml.

I recommend you to get second opinions after the consultation of January.

Best wishes and luck in this journey. 

VG 

 

Clevelandguy

More testing

Hi,

If it was me I would monitor your PSA for the next few months to determine if your cancer is growing.  With a robotic prostatectomy your PSA should be undectable after one year if your cancer has been eradicated.  I would also start looking for a good radiation oncologist.  As Vasco stated sounds like you need a PET scan to locate any remaining cancer. Prostate cancer can be slow growing so it might take some time for the escaped cancer to "show up" on any scans. Several types of radiation treatments are available which you should discuss with your cancer team.  Remember great doctors+great facilities = great results, second opinions might not be a bad idea if you feel the need.

Dave 3+4