Very Slight increase in PSA

Tico14

I had a RALP in 2018. No problems, PSA was low to begin with. I just wanted the cancer gone. PSA tests periodically since all virtually undetectable. First positive reading was in September of 2023, when it was, .04. Noted, but no big deal. September of 2024 .06, then today, February 2025 .09. Question. Do these numbers ever reverse and get smaller or am I more than likely facing the BCR at .2 in maybe a year and a half or sooner? Thanks.

Wheel

If your PSA numbers are a trend towards BCR, it’s not like in the past when you reached .2 it was immediately labeled BCR and felt you needed treatment. At that point it still is likely BCR but now typically waiting for treatment until .5 to 1.0 for PSA driven and up to 2 for allowing PET imaging , so it’s possible it could still be time before you actually needed treatment depending if your PSA continues to rise. Again in the past , treatment was PSA driven and then the Radiation had no target. Today Radiation can be so much more focused and with the advent of PSMA PET scans, treatment is becoming image driven having a target for the Radiation letting the PSA to rise to 2.

Tico14

Wheel, thanks. That makes sense. I appreciate it.

Wheel

Tico,

A big example of how advances in technology and treatment are always improving through time is shown in a video Steve1961 shared. A doctor at UCLA Dr Reiter is behind a new surgery years after a RALP when it appears the cancer has resurfaced often in the lymph nodes. Although the PSMA Pet will show the lymph nodes, the specific nodes cannot be identified so the whole area is off to Radiation and maybe hormone treatment. This new surgery with advanced technology allows the surgeon to go in and through testing while in surgery identify the specific individual lymph node or two that are cancerous and just remove those and not have to undergo Radiation. It appears successful but I imagine still in clinical trials at UCLA.

He recently posted the video under the thread “My case high PSA post prostatecomy”started by jpeters88 on 2-16-25

Tico14

Wheel, Just watched the video. Sounds like a game changer. Thank you.

Clevelandguy

Hi,

A few more PSA tests should show you if you have a upward trend going. If you have an upward trend you have all the various radiation treatments at your disposal. Check with your doctor team to discuss future treatments. A PMSA PET scan might not be a bad idea to pinpoint where the cancer is migrating.

Dave 3+4

On_A_Journey

Hi @Tico14 , nice to get the chance to reply to you again. To answer your question, it does look like you might be heading to BCR territory in the next year or so. @Wheel 's reply to you was on-point. Even if and when you do reach BCR, it's not a big deal.

Two things for you to consider: (1) Readings can, and will, fluctuate or stabilize at any time, without rhyme or reason. Like you, I also went from 0.04 (which was my PSA nadir two years after my salvage radiation following my failed surgery) to 0.06 in 12 months. A year later it was 0.11 and it was 0.16 six months after that. What was really interesting for me was what happened after that. I was on a 3-month follow-up frequency then apart from one that I skipped, and my next test was 0.19. But my next two tests were both 0.18! The one after that was 0.20, a full year after my 0.19 reading! My PSA had flatlined! More recently, my past five readings have been 0.59, 0.54, 0.74, 0.67 and 0.77. All over the place! The overall trend and calculated doubling time based on your previous five readings once you do reach BCR is more useful to determine the aggressiveness of your residual cancerous cells.

(2) Even when you do jump the BCR hurdle, it does not mean that treatment is imminent. I've been in that territory for three years now and I'm still on active surveillance, with 3-monthly PSA tests and follow-ups. Yes, it's a pain in the 'proverbial' to structure your life around getting blood drawn every three months and keeping an appointment to discuss the results, but it is worth it.

Don't worry, be happy etc.😀

Tico14

OAJ, Cleveland, thanks for your replies. A couple of years ago my urologist hinted that a PSMA could be in my future so I've read about it. I know I should've taken the WW or AS track before my initial surgery, but there's not much I can do about that. However I'm definitely going to take my time, should the BCR become a reality.