Early sign of recurrence after prostatectomy - when to act?
Prostatectomy 2.5 years ago. Undetectable PSA for 2 years, then went from 0.017 to 0.032 in the past six months.
Originally Gleason 3+4. 7mm positive margin after the surgery.
So on the one hand there is a pretty good indication of an early cancer recurrence and a "strong clue" as to where it is (the positive margin).
But my UCSF surgical team wants to wait and do more diagnostics. They want to wait until 0.1 for an ultrasound and at 0.2 they want PSMA PET. They feel any PSA under 0.5 is still likely to be confined to the pelvic area and it’s better to wait and see, because maybe it's actually somewhere else like a lymph node.
But I’m only 50. I need to eradicate this. I honestly think their program of offering me active surveillance for four years with a 3+4 was a bad call. We missed one chance to wipe this out already.
And what if the PSMA PET doesn’t show anything at 0.2? Do we wait for 0.3? 0.5? Wouldn’t that increase the chance of it spreading?
For context, my dad died from this because his team was too nonchalant (at Mayo, also a center of excellence). They let him go years without a follow up biopsy even though he was high risk. My trust in "confident and experienced" teams is running thin.