r/ProstateCancer • u/OutsideReady2480 • 3d ago
Question PSA Increase?
Had RALP in April 2025, gleason 9 with large cribform present and margin were really close but not over on left side and surgical margin on right side was positive. I had a PSA test every 3 months and everyone of them read <0.01 for the 1st year. Doctor moved the test to every 6 months and had my PSA today come back at 0.02, and has now registered on my graph that my chart keeps. To you guys is this an increase or a possible blip and should I be concerned.
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u/ChillWarrior801 3d ago
You're gonna be OK. With all that high risk adverse pathology, an 18 month run before your PSA became detectable is an accomplishment in itself.
I'm in a similar boat. I also have high risk pathology and a RALP back in January 2024. My first detectable PSA was in September 2024 (0.03). It's 0.15 in October 2026. What's most important now for high risk guys like us who started out undetectable for a long stretch is to stay on top of PSA doubling time. It's your call about whether you'd like to be tested more frequently than 6 months. I prefer a 3 month cadence, because I want more data to drive decisions. Other guys might have mental health issues with more frequent testing, and they'll do OK with a 6 month cadence too. Do what works for you.
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u/Ok-Priority-7303 3d ago
FWIW I'd stick withe every 3 months. I have Gleason 9 and opted for radiation. I had 2 biopsies four years apart - went from benign to Gleason 9 so I am wary about waiting 6 months indefinitely.
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u/OkCrew8849 3d ago edited 3d ago
A PSA increase from <0.01 to 0.02 with your clinical picture (Gleason 9 with large cribform present) will most likely result in a shift to 3-month PSA interval . This is NOT saying this is necessarily the time to treat and this is NOT saying you have met any formal definitions of reoccurrence.
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u/OutsideReady2480 3d ago
That's what I kind of figured. Back to 3 month checks. I meet with my doctor next week and hopefully we can get a plan in place and move from there. Thanks for the info
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u/Intrinsic-Disorder 3d ago
Mine went from undetectable to 0.01, 0.02 and 0.03 on subsequent tests. This plus high DECIPHER and positive margin was enough to initiate salvage therapy. You should track the trend and discuss with your team.
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u/TheEndIsSighing 3d ago
Can I ask where you treated? I'm with Dana Farber and my surgeon and RO both a) only use regular PSA not UPSA and b) won't move to salvage until it's at least 0.1 and seen to be moving up.
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u/NotPeteCrowArmstrong 3d ago
What was your post-surgical pathology?
There is plenty of support in recent research for the benefits of ultrasensitive PSA testing after RALP if you have any factors that might elevate your risk of recurrence (e.g., higher Gleason score, positive margins, extraprostatic spread, high genomic or genetic risk, etc.) Doing so can give earlier insight into potential recurrence and more precision for determining PSA doubling time.
Many practices still stick with the standard PSA test that only reads down to 0.1, but that seems increasingly at odds with what research suggests, even if it's not yet standard of care.
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u/planck1313 2d ago
I assume the rationale for only testing down to 0.1 is that 0.1 is typically the threshold at which salvage radiation would start to be considered.
Meaning that testing below that level has no utility as a detectable PSA below 0.1 will not result in any change in treatment while perhaps causing unnecessary stress to the patient.
The counter argument is that if a true recurrence is occurring then uPSA data will give more information about its timing and doubling time.
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u/TheEndIsSighing 2d ago
I had many negative factors - EPE in 3 places, higher Gleason, positive margins (and they absolutely don't do genomic testing) - and every doc there (Dana Farber) said they only use regular PSA. My Radiation Oncologist only does prostate radiation, nothing else.
It's fascinating the differences between excellence centers.
As Planck below said, below .1 they will never advise salvage treatment...
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3d ago
[deleted]
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u/OkCrew8849 3d ago
"gleason 9 with large cribform present and margin were really close but not over on left side and surgical margin on right side was positive."
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u/NotPeteCrowArmstrong 3d ago edited 3d ago
That's OP, not the commenter I was responding to. I deleted my comment reflexively when I read your note saying I missed that info, but then I realized it's you who are confused.
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u/TheEndIsSighing 2d ago
I had large cribiform, EPE in 3 and margin presence in 3, Gleason 7, and super fast growth from no cancer to holyfuk in around 9 months between biopsies.
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u/planck1313 2d ago
Starting salvage radiation at only 0.03 is very unusual and while if a case has particularly bad clinical characteristics its something that could be considered there are risks.
The first is that the 0.03 turns out not to be a dangerous recurrence and so the salvage treatment, which can have side effects, was unnecessary. The second is that at such a low PSA a PSMA PET is that much likely to find the site(s) of recurrence and studies have shown that a positive scan result does influence the treatment plan in a majority of cases.
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u/Intrinsic-Disorder 2d ago
It is unusual but I am in my mid-40's, high DECIPHER, Gleason 7 (3+4), positive margin and 3 consecutive rises on the PSA test all made the case.
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u/qrs312 2d ago
Im in similar situation with same pathology, decipher .72 , except am older, 67. Talked to 6 RO's! Two would have treated at my .04 PSA, four wanted to wait until approached .1. My PSA then dropped to .02 and has held for 6 months so far. Doing monthly tests, fairly stressful.
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u/Intrinsic-Disorder 2d ago
Tell me about the stress! After radiation, my first PSA came back at 0.02 still and I cried my eyes out. After 2 months, I'm back to undetectable! It may highlight the noisiness of the ultra-sensitive levels but I'm hoping we got the left over cancer with the salvage treatment. The relatively large positive margin was always haunting my thoughts, so I'm glad to try and nuke anything remaining there while it was still small (hopefully). Thankfully, I found radiation pretty easy and have not had any major issues except it flared up a hemorrhoid. Best wishes to you for more PSA decreases!
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u/planck1313 2d ago
In those circumstances being so young with bad clinical features I can understand why you acted so quickly.
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u/CombOdd2117 3d ago
I’d love to hear experience on this as well. My psa was 0.00. Latest was 0.09. Very nervous about retesting next month.
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u/TheLawOfDuh 3d ago
Don’t panic yet. Wait for your urologist to investigate. A .01 isn’t a true reason to panic, more a reason to monitor and possibly test more often. Talk with your urologist who will explain how to navigate any changes.
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u/tober_checki 3d ago
Highly sensitive can help to determine the doubling time early on. This is good to decide on diagnostic and therapeutic measures early. The downside is that we get scared easily. I am Gleason 9, too, and would certainly be scared if my PSA went from undetectable to .02. Keep monitoring it, it may just be noise. If it is a real, persistent increase, between .1 and .2 is where you need to take action. Where that means PSMA PET/CT first to figure out what is going on.
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u/planck1313 2d ago
Keep testing every three months. One result at 0.02 could just be random noise. A true recurrence will result in a consistent rising trend over time. The more data points you collect the easier it will be to see if that trend exists.
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u/Creepy-Project2453 2d ago edited 2d ago
I personally prefer information and don't mind getting a little blood test poke, so it rubs me a bit when I hear a Dr. deciding what I don't need to worry my little head about. That's just my personality I guess. You will know whether it is a blip in 3 months when you get the next test. I am 10 months behind you, now 66, and I have been gaming this out a bit in my mind too. My ultrasensitive test is <0.006 for undetectable, three very fortunate data points so far. If it isn't a blip, then your 0.02, repeated or growing, is not nothing (it is ~3-4x another assay's 'undetectable') and careful investigation about best timing for adjuvant radiation would then be my number 1 agenda. If earliest possible radiation has better outcomes and, especially for me, lower need/chance of ADT, I would feel compelled to get right after it. Age, co-morbidities, etc. change the calculus. You are on top of this! I hope it is a blip for sure. If not, in this scenario, I personally would never wait for PET to be able to see remote tumors, which I understand means sitting on your hands for quite a bit longer. This is about that bit of positive surgical margin you had and whether you want to act on that assumption.
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u/planck1313 2d ago
In these circumstances where an undetectable PSA goes just detectable there are four possible scenarios:
1. It is cancer and it will become a threat to your health
2. It is cancer but it is so slow growing that it will not threaten your health, at least not until after you die of something else
3. It is not cancer, it is a random testing blip
4. It is not cancer, it is residual benign prostate tissue.
The only way to tell which it is is to continue regular uPSA testing.
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u/SanctifiedChats 3d ago
The lab that I go to doesn't even perform high sensitivity PSAs, they simply say that it is less than 0.1 if it's undetectable and that is fine with my urologist. I've had two PSAs performed since my ralp 6 months ago.
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u/TheEndIsSighing 3d ago
May I ask where you're treating? My SO and RO agree with your providers - anything under 0.1 is undetectable so no salvage.
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u/OkCrew8849 3d ago
I tend to want the earlier warnings from a more sensitive PSA…but not so sensitive it is subject to undue noise and fluctuations.
MSK goes down to >.05 and that seems about right to me.
Since I have seen the needle move towards earlier post-RALP salvage (and the planning for post-RALP salvage) I’d be wary of a PSA that bottoms out at <.1 nowadays.
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u/SanctifiedChats 2d ago
Yeah it would be nice to have the sensitive measurement so I really know. But if it came out high I'd end up getting it redone anyway. It only costs $30 to have it done by an outside lab. Also, I'd like to mention I'm taking various supplements as part of my ongoing anti-cancer regimen. I did that for 12 years on active surveillance. Lately that includes ivermectin and fenbendazole. I'd link articles here but last time I did that people took offense and I got banned for 30 days because they didn't like scientific articles that went against their narrative. :(
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u/my2bits4u 3d ago
I wouldnt get that excited . Mine was 8.2 3 months before and 6.1 a week before .same lab. Its no exact science it is kind of a guideline
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u/planck1313 2d ago
He's talking about post surgery PSA levels, which should be undetectable if all of the cancer was removed.
A detectable result does not necessarily mean cancer is present but its something to keep an eye on.
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u/Holiday-Bet7389 3d ago
WHAT ARE YOUR T-LEVELS FROM THOSE RESULTS?...MY DECIPHER OF 0.63 STATED THAT DOING 6 MONTHS ORGOVYX WHILE ON RAD FOR BED AND PELVIC SHOULD GIVE GREAT RESULTS WHEN PSA IS BELOW 0.1..MINE TOOK 1&1/2 YRS TO GO FROM UNDETEC TO 0.03 FOR ME TO ELECT THE RAD SERIES...I'M 2 YRS FROM THAT AND HOPE MINE STAYS UNDECT.....BE PRO-ACTIVE..THIS BEAST DOES NOT WAIT OR TAKE A VACATION
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u/jkurology 3d ago
You had high risk disease so frequent (every 3 month) PSAs make sense