PSA of 0.1 18 months after robotic prostatectomy

A prostate-specific antigen (PSA) level of 0.1 ng/mL measured 18 months after robotic prostatectomy is a very low value. The clinical significance of this level primarily depends on the trend of serial PSA measurements, as biochemical relapse after radical treatment is defined by a rising PSA ¹. Key considerations for this PSA level include:

• Follow-up Schedule: After radical treatment, PSA levels should be checked no earlier than 6 weeks post-treatment, at least every 6 months for the first 2 years, and then at least once a year thereafter ¹. A measurement at 18 months aligns with this recommended schedule.
• Biochemical Relapse: Biochemical relapse is indicated by a rising PSA after radical treatment ¹. While 0.1 ng/mL is low, it is crucial to compare it with previous PSA values, especially the nadir (lowest point) achieved after surgery. If this represents a rise from an undetectable level, it could signify biochemical relapse.
• Analysis of Serial Levels: Serial PSA levels after radical treatment should be analysed using the same assay technique ¹.
• Management of Biochemical Relapse: If a rising PSA indicates biochemical relapse:
  • A rising PSA alone should not necessitate an immediate change in treatment ¹.
  • Estimate the PSA doubling time, based on a minimum of 3 measurements over at least a 6-month period ¹.
  • For people with biochemical relapse after radical prostatectomy and no known metastases, radical radiotherapy to the prostatic bed should be offered ¹.
  • An isotope bone scan should be offered if symptoms or PSA trends suggest metastases ¹.
  • Biopsy of the prostatic bed should not be offered ¹.
  • Hormonal therapy should not be routinely offered unless there is symptomatic local disease progression, any proven metastases, or a PSA doubling time of less than 3 months ¹.
  • Consider entry into appropriate clinical trials ¹.