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/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/planck1313 3d 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 3d 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/planck1313 2d ago

In those circumstances being so young with bad clinical features I can understand why you acted so quickly.