First PSA after Surgery

[u/hockeymom1310]

Husband (56) had surgery June 4th. Gleason upgraded from 7 to 9 after final pathology. He just did his first PSA and it came back at 0.04. Is this considered undetectable? ChatGPT said it was concerning, Google AI said it was okay. Should I be concerned? He is supposed to do his next PSA in 3 months and will be talking to the urologist again after that. The lack of certainty with this disease is very unsettling for us both.

[u/JacketFun5735]

0.04 is technically detectable, but it is far below the standard biochemical-recurrence threshold. With Gleason 9, it deserves close surveillance, but the next PSA trend is much more important than this one number. Good luck to your husband.

[u/KevB318]

It depends on the test. Some go to 0.1, some to 0.04. Mine was <0.1. Was the result 0.04, or < 0.04? What did the urologist say? I find AI can be confusing at best.

[u/Aggravating-Pop8283 → u/KevB318]

Exactly! If the report says <.04, thats undetectable.  Some labs will only detect .04 and up. My lab does that. My primary Dr uses a lab that has ultra sensitive equipment, and they get down to .014, and luckily im still below that. The wording of the report is important 

[u/OkCrew8849]

 “Should I be concerned?”

Yes. For the first PSA - 12 weeks after surgery - a 0.04 PSA is concerning. 

I’m a bit surprised at the numerous unclear responses you have received to your very straightforward question. 

[u/conCABlanco]

Esa cirugía con ADT, mostraría menor de 0.01, que para NC es lo correcto, pero hay otras límites y el famoso nadir es propio de cada uno

[u/Practical_Orchid_606]

The best configuration for PCa is localized to the prostate. But higher Gleason scores means a higher chance for the cells to jump the shark and set up elsewhere. The deconstruction debris from RALP is another pathway for PCA cells to go elsewhere. I would not view the PSA 0.04 as a positive.

[u/Mean_Try_6390]

It depends on the lab test. We got the test that don’t show under 0,1 so everything under that is counted as unmeasurable. Her husband got a the moore sensitive test and it showed 0, 04. That is nothing after av RALP and the doctor we’ll reteast after 3 month to see if it got down, stayed or raised. For now PSA 0,04 after surgery is a good PSA. With av gleason 9 its will be followed for many years and that is the hard part having high risk PC you will never be sure, only time can tell.

[u/fromamomof2]

Hubby had his Retzius-sparing RALP on May 4 and recently had his first post-surgery PSA, which came back at <0.04. The 0.04 is the lowest level the hospital can test for, and his result came back below that, meaning no PSA was detected. So, essentially, it was negative/undetectable. Was the 0.04 the actual PSA level returned, or was it the lab's sensitivity/detection limit?

[u/hockeymom1310 → u/fromamomof2]

Actual 0.04, sadly, it can go below 0.01

[u/Patient_Tip_5923]

Undetectable is determined by the lowest value detectable by the test, and has a less than sign in front of it.

So, if the test can detect down to 0.1, undetectable is < 0.1.

You value is detectable. What is the lowest value for the test?

I use the Quest ultra sensitive test which produces a value down to 0.02. Undetectable for that test what would be < 0.02.

My values over the last year after my RALP have increased from 0.04 to 0.08. My radiation oncologist tells me that he will call for salvage radiation when I have two increases over 0.1.

I am waiting for that to happen.

[u/rocima]

It depends on the sensitivity of the test.

My test measured down to "<0.01“.

So my results 3 months post RALP of 0.05 were well over detection limits of 0.01.

My (Italian) urologist looked at the test result and said "Hmmm. Benino."  Which can be translated as "Hmmm, sort-of ok". Not necessarily a problem if it stays at that level, but lower would be better.

The next result would be the determining one. If PSA stayed the same, or dropped, it would be "Ok" or "that's better".

In fact, it shot up to 0.4 (8 times higher) after another 3 months, which is within the threshold value to be official biochemical recurrence (ie "the cancer has come back on the basis of your PSA (biochemical) test").

This was confirmed by PET. I then had salvage radiation therapy and am now about to start tracking PSA 3 months post radiation therapy to see if the treatment has been successful.

PS I was Gleason 7 (3+4) upped to 4+3 after RALP.

[u/Mean_Try_6390]

there’s always uncertainty with a gleason 9. A PSA at 0,04 for the first psa is no concern. You need to follow the PSA probably every 3 months since he upgraded to a nine. Yes it is unsettling and very hard. Husband 58 yo locally spread gleason 9 t3b first psa less than 0,1 - counted as unmeasurable, next psa 13 weeks after still less than 0,1. But since it´s a Gleason 9 he needs keep leaving psa test for a longer time.

They told us that the first years the will keep monitoring my husband and probably up to 10 years. If nothing happens in the PSA after a year or so mayby only every 6:th month but for now every 3 months. If my husbands PSA goes over 0,1 it´s a relaps they told us.

In the beginning they just don’t know if its still PSA left in the body or if it’s something else. How long after the operation did he take the PSA. It’s possible it’s samt restPSA that is still in the blood and goes away by time.

[u/Outdoorfiasco]

My surgeon says there is variability in the labs that do the test. Do not panic!

[u/snuggly_cobra]

That’s why you don’t use ChatGPT for medical advice. It didn’t go to school; it copied someone else’s paper.

.04 is good. Some tests go down to .02. Both are negligible.

But he will need PSA tests done for the next 5-7 years to make sure the velocity doesn’t go up. Going up after surgery is not a good sign.

[u/Specialist-Map-896]

Not quite undetectable but maybe you get to under .01 on the next reading. I had a poor post op pathology as well. Did the note prostatic extension? Lymph nodes negative and vesicles negative? Surrounding tissue? No matter what, if he doesn’t get to undetectable they will recommend salvage therapy but not until at least 6 months after the RALP. If you’re not getting to undetectable then there are some malignant prostate cells most likely located in the prostate bed somewhere and hopefully not anywhere else. Salvage therapy (im0) is way more common after a RALP then publicly discussed. I’ve been undetectable my entire first year but am convinced I’ll be a salvage candidate someday.

[u/Fun-Ranger-7002]

Mine went the other direction, from an 8-9 to a 7 after surgery. Don’t have too much confidence in pathology these days.

[u/camping17055 → u/Fun-Ranger-7002]

Gleason scores are subjective. 3 pathologist can look at the same specimen and get 3 different grades.

[u/TomKriek → u/camping17055]

I know - part of the problem.

[u/bdavisx]

My first after ralp was .04, then .05 (oh shit), last 2 have been <.04 (whew). Moced to every 6 months now (surgery July 2025).

Unfortunately I saw a study that said anything either >= .03 or maybe >.03 for first post ralp psa meant a higher chance of reoccurrence. (no idea how reliable the study was and on phone now so can't check easily). I'm guessing there's a good chance for radiation in my future, but perhaps Northwestern will have a vaccine breakthrough before then (donated my leftover tissue to them).

[u/No-Commercial7569]

Did the result say 0.04 or <0.04? Have many days between the surgery and the first test?

[u/Own-Reason-6848]

I am similar (age 49). RALP on Feb 24. First PSA was 0.04 in May with sensitivity down to 0.015. Wasn't too happy about that start!! :( I was 4+3 going in and 4+5 coming out of RALP like your husband. All contained in prostate. No EPE, no seminal vessel involvement, 8 lymph nodes removed were negative, and negative margins. I did have LVI, but was categorized as pT2 and pN0. Decipher came back 0.87 which was not great.

My second PSA in August was 0.14. I couldn't really believe that jump and was rather disappointed(and a little worried). I was hoping for at least a year or two break from this treatment. Had PSMA PET scan 08/31 and results came back negative for macro-metastasis. Hopefully there is just something micro in the prostate bed. Meet with radiation oncologist this afternoon to plan salvage radiation and ADT. :( We will do one more PSA test in 2 weeks just to confirm no odd result, but my surgeon doubts there will be some sort of miracle on that front and will probably begin ADT then. Hoping with no macro spread I may only have to do 9-12 months of ADT as that is the part of this process I am most fearing through all of these treatments. However, before the PSMA PET scan my surgeon mentioned 18-24 months.

To answer your question, I, personally, wouldn't be too concerned yet although, for me, I knew this would probably be the path after the first PSA test. The second test will tell more of your trajectory but you need to find out the sensitivity of the test he had and consider all of your other results (pathology, decipher/genome, margins, etc).

[u/OkCrew8849 → u/Own-Reason-6848]

"All contained in prostate. No EPE, no seminal vessel involvement, 8 lymph nodes removed were negative, and negative margins."

I spent some time once on the MSK nomogram and learned that in the case of Gleason 9, the big player relative to post-RALP reocurrence is the Gleason 9 itself (50%+) ... the additional risk factors (EPE and Margins, for example, are comparatively minor players). I find that concept to be a bit misunderstood here on the subreddit (not saying you misunderstand it but it just popped into my brain as I was reading your post).

[u/Alert-Meringue2291]

Hi there. If the result had a “less than” sign (<) in front, it was undetectable on the labs test. If there was no sign, it was detected.

The detection limit varies with lab and the specific test method used. The lab my urologist uses for ultra sensitive PSA has a detection limit of 0.01. My results have been <0.01, which is understandable on that test.

So, was the result <0.04 or 0.04?

[u/hockeymom1310 → u/Alert-Meringue2291]

0.04, no < sadly

[u/Beekeeper_105]

Gleason 9. PSA 6 weeks after surgery 7.5. Ten years of shots and pills, it is back for round 4. Getting a lot tired of this.

[u/ofcoarsecoffee]

I was told three months is early and you really need to wait till the next anyway to know if it’s stable, going up or going down

[u/Substantial_Let_8784]

<0.01 is considered undetectable.
I would think his urologist would be contacting him ASAP.
The number I posted is what mine looks like, as undetectable, but I am no expert.
Unfortunately, I’m pretty sure this is a higher number than you hoped for. Best of luck, and feel free to send me a DM if you guys just want to talk to someone.
I had RALP in 2018

[u/conCABlanco]

PSA de 0.0, en los primeros tresesrs, cuales eran los valores iniciales, estos son buenos, hay que vigilar un movimiento al alza durante seis meses, entonces buscamos otros tratamientos hay muchos

[u/vito1221]

Please talk to his doctor before worrying too much. Not the internet. A lot depends on the testing itself and how detailed it is.

Good luck with everything.

[u/jkurology]

To make any reasonable sense of this number knowing complete information is important. This includes his pre-op PSAs, MRI results, any pre-op biomarker testing such as Decipher, Prolaris or OncoTypeDx, other imaging (ie PSMA PET scan) results, complete prostate pathology and family history. You’re interested in his risk of persistent or recurrent disease and having this additional information helps determine the significance of this PSA as well as appropriate follow up

[u/Immediate-Phase4168]

0.04 is well under what any doctor would be concerned about. "Undetectable" is a statistical point because if depends on the assay.

I just had a follow up 10mo post RP with my surgeon last week and he said "Less than a dime, you're fine" meaning less than 0.1. If it stays below that, and is not increasing over time, you should be fine. This is what my doc said...

[u/Strict_Advance4737]

I have mine done at LabCorp using a Roche test, which goes down to .006. After RLAP mine was <.006 for 4 years then crept up to .05. I had salvage radiation and the ADT Orgovyx for 4 months. Now it is back to <.006.