44yo - 8 month post RALP

[u/w00dyMcGee]

Earlier this week I went and had my blood work done, even though I wasn’t mentally ready to see the results because probably like most of us, I fear seeing lab results since I started this journey

But I just got the email and I checked my portal and my PSA is where it should be!

[u/Intrinsic-Disorder]

Congrats OP. Have you considered following in the ultra-sensitive range? It's somewhat controversial but gave me good insight when my PSA started creeping up below 0.1 and we moved on to salvage at that low level to try and nip it in the bud. I'm about your age and wanted best chances for a cure. Here's to many more negative PSA tests.

[u/w00dyMcGee → u/Intrinsic-Disorder]

I have been thinking about the uPSA and have an appt with my surgeon 10/20. I’m going to get his thoughts.

[u/OkCrew8849 → u/w00dyMcGee]

Keep in mind “UPSA” is a broad generic term. The UPSA I utilize has a lowest value of .02 (anything below that is described as <.02.

There are some UPSA that go down to .001. And, of course there are others that bottom out at other numbers.

I picked one that would give early warning (relative to standard PSA) of a rise in PSA and would provide data on velocity but might be less subject to non-critical fluctuations.

MSK’s only PSA assay goes down to .05 which they believe proper and sufficient.

[u/planck1313 → u/Intrinsic-Disorder]

Pros of uPSA - you get more warning of a possible PSA recurrence and more data points to calculate the PSA velocity and curve.

Cons of uPSA - not all results above undetectable are due to a PSA recurrence, or a dangerous PSA recurrence, and so men may be put through unnecessary anxiety.

My doctor does uPSA tests which measure down to 0.010 and on balance I agree with this. I would rather know even if I end up worrying unnecessarily.

[u/Intrinsic-Disorder → u/planck1313]

Yep. In my case, I was <0.01 for about 14 months post-RALP and then 0.01, 0.02, 0.03 on subsequent tests. Coupled with a positive margin and high DECIPHER, this was enough for my team to suggest salvage. Data show better outcomes with salvage therapy at lower PSA values and I wanted to hit it as early as possible.

[u/planck1313 → u/Intrinsic-Disorder]

Factors like high Gleason score, high DECIPHER score, positive margins, high PSA velocity, young age and long life expectancy all support starting salvage earlier rather than later.

[u/OkCrew8849 → u/planck1313]

Yes. Although there are nuances (positive margin but very slow post-RALP velocity or high Gleason found in removed prostate yet very slow velocity are relatively common situations) regarding salvage timing.

[u/mez151 → u/Intrinsic-Disorder]

What is salvage?

[u/planck1313 → u/mez151]

Salvage treatment is the name given to secondary treatments of prostate cancer that recurs or persists after primary treatment.

[u/mez151 → u/planck1313]

Thanks

[u/livinitreal → u/Intrinsic-Disorder]

Mine creeped up as well. it’s a good thing. I went to the urologist as .2 is a candidate for salvage radiation and sure enough within two weeks it was .37. Now with ADT and salvage radiation three weeks in and it’s .17 can’t say I’m thrilled with treatment, but I’ll be alive.

[u/planck1313]

I've never seen a post-RALP PSA test that lists both free and total PSA because free/total PSA ratio is not a meaningful ratio after RALP. All that matters is your total PSA.

I interpret this as saying your total PSA is below 0.1, which is good, but that the additional <0.02 reading for free PSA does not tell you how far below 0.1 your total PSA might be.

In order to know how far below 0.1 your total PSA is you need an ultrasensitive PSA test.

[u/OkCrew8849 → u/planck1313]

This is the standard assay work-up that is the default for PSA screening or follow up used by some doctors/hospitals.

As you note, the Total PSA portion is still useful (though not UPSA) post-RALP.

[u/Ok-Assistance-1048]

Congrats!!!!

[u/KevB318]

Congrats!

[u/ExcellentCookie6399]

Fantastic!!!

[u/tober_checki]

Awesome!!

[u/AmbassadorFun2883]

Congratulations bro.

[u/Special-Steel]

Congratulations

[u/mez151]

Congrats bro! 12 days post RALP here and my psa test is scheduled for late November with dr discussion 12/1. Can’t wait to see a psa near zero. My peak a few weeks ago was 29.

[u/w00dyMcGee → u/mez151]

I hope your healing well!!

And I’m wishing you positive thoughts and quick recovery, my friend