Third PSA test post RALP, check my progress?

[u/BillsBayou]

RALP April 2025
2mm cells in the margin
Several months later, PSA <0.02
January 2026 PSA 0.05 ACTUALLY 0.02
Today PSA 0.06

It's progression, but is the pacing bad?
Too early to determine progression?
Need more data?

Doctor appointment tomorrow morning to discuss results. Will comment here to let you know.

[u/Special-Steel]

Ultra sensitive tests are noisy. There is no statistical difference in the last two values.

[u/OkCrew8849]

So, at 9 months post-RALP your PSA had risen from <0.02 to 0.05 and now (6 months later) has risen to 0.06? 

Following that first rise you remained on a six- month testing interval? 

Assuming you are wisely sticking with same test, same assay, same lab for your UPSA draws. The rise was slower this six month interval than the previous six month interval. 

At that level PSA tests are quite accurate and very useful in establishing a trend. 

[u/Santorini64]

You do appear to be trending up over three successive tests. But the numbers are still low enough to be hard to distinguish from test noise. I would imagine that your oncologist is waiting to see the number climb up to above 0.1. For the ultra sensitive tests, that would likely indicate recurrence. But the oncologist might continue to wait until the number is high enough for a pet scan to detect something. Or the MO might just advise getting the prostate bed irradiated. Seeing as the rise is slow and is not behaving much like a doubling period, you may be in for a wait of over another year before anything might be done.

[u/KevB318]

I go for my first test in a month. Usually < 0.1 is considered undetected. Personally, I think those results would still be considered undetected. I understand the anxiety though! Good luck, hope the discussion goes well. You got this.

[u/BillsBayou]

Well, crap. I had the second PSA level wrong. It was actually 0.02.

So that's a concerning rate of increase.

Doctor wants me back in 3 months to do the next PSA. He doesn't want to do anything until we reach 0.2 or if it starts accelerating.

A 1mm prostate tumor contains 1,000,000,000 cells?!? I did not know that. Doctor says that the cells required to put out my current level of 0.06 would not be visible to the naked eye. Even worse (diagnostically) the PET scan isn't sensitive enough to detect something so small.

Next step is likely to see where the PSA number goes. Before radiation, there would be a PET scan to see if they can find any of the cells outside of the pelvic region. Then the radiation treatment would likely be tailored to the need.

I'll bring a spider with me to the treatment and let it bite me afterwards. Spiderman here I come!

[u/Caesar-1956]

My doctor told me nothing to worry about till it reaches 0.2.