YOU STOPPED AT: CATEGORY 3: PSA >0.020 ng/mL (UNLIKELY - Rare)

COMPLETING: CATEGORY 3 PSA ELEVATION & WHAT IT MEANS FOR YOU

Let me finish this important section about what elevated PSA results would mean, and then provide your complete next steps.

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CATEGORY 3: PSA >0.020 ng/mL (UNLIKELY - RARE)

CATEGORY 3: PSA >0.020 ng/mL (UNLIKELY - Rare for Post-RARP Patients)

⚠️ What This Means:
✗ PSA has risen above expected range for your surveillance
✗ Suggests possible biochemical recurrence
✗ Requires immediate further evaluation
✗ Does NOT automatically mean cancer has returned
✗ Could indicate benign causes (infection, inflammation)

Why This Is Unlikely in Your Case:
✓ You're 2-5 years post-RARP
✓ Your previous PSA levels have been ultrasensitive (<0.010 ng/mL)
✓ You've been stable on surveillance
✓ Sudden jump to >0.020 ng/mL would be unexpected
✓ Probability: <2% based on your history

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IF YOU GET A PSA >0.020 ng/mL RESULT:

Immediate Actions (Same Day as Result):

1. CONTACT YOUR ONCOLOGIST'S OFFICE
   □ Call immediately (don't wait)
   □ Ask to speak with your oncologist or nurse
   □ Say: "My PSA came back at [X] ng/mL, which is higher than
     expected. I need to discuss next steps."
   □ Ask: "Is this concerning? What should we do?"

2. CONFIRM THE RESULT
   □ Ask: "Could this be a lab error?"
   □ Ask: "Should we repeat the PSA test?"
   □ Ask: "When can we repeat it?"
   □ Most oncologists will order repeat PSA within 1-2 weeks
     to confirm elevation

3. REVIEW YOUR RECENT ACTIVITIES
   □ Did you follow pre-test precautions?
   □ Did you have any urologic procedures recently?
   □ Did you have a UTI or urinary symptoms?
   □ Did you have vigorous exercise 48 hours before test?
   □ Did you have ejaculation 48 hours before test?
   □ Did you have bicycle riding 48 hours before test?
   □ Share this information with your oncologist
   □ It may explain the elevation

4. DOCUMENT YOUR SYMPTOMS
   □ Any urinary symptoms (dysuria, frequency, urgency)?
   □ Any fever or signs of infection?
   □ Any pelvic pain or discomfort?
   □ Any other new symptoms?
   □ Share with your oncologist

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WHAT YOUR ONCOLOGIST WILL DO IF PSA >0.020 ng/mL:

Step 1: Repeat PSA Test (Within 1-2 Weeks)
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Why: To confirm the elevation is real, not a lab error

If Repeat PSA is ≤0.010 ng/mL:
✓ Original elevation was likely benign (lab error, activity, etc.)
✓ Return to routine surveillance
✓ Next PSA in 6 months
✓ No further workup needed

If Repeat PSA is 0.011-0.020 ng/mL:
⚠️ Elevation is confirmed but modest
⚠️ Repeat PSA again in 4-6 weeks
⚠️ Watch for PSA doubling time (how fast it's rising)
⚠️ If PSA continues rising: Consider imaging

If Repeat PSA is >0.020 ng/mL:
🔴 Elevation is confirmed and significant
🔴 Proceed to imaging studies
🔴 Evaluate for biochemical recurrence

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Step 2: Imaging Studies (If Elevation Confirmed)
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According to NCCN (National Comprehensive Cancer Network) Guidelines
for prostate cancer surveillance after radical prostatectomy:

"If PSA rises above nadir and is confirmed on repeat testing,
imaging studies should be considered to evaluate for recurrence."

Your oncologist may order:

OPTION 1: Multiparametric MRI of Pelvis
✓ Best for detecting local recurrence
✓ No radiation exposure
✓ Takes 30-45 minutes
✓ Can detect tumors as small as 5mm
✓ Cost: $1,000-2,000

OPTION 2: PET/CT Scan (PSMA or Choline)
✓ Best for detecting metastatic disease
✓ Uses radioactive tracer to find cancer cells
✓ Takes 2-3 hours
✓ Can detect distant metastases
✓ Cost: $2,000-3,000

OPTION 3: Both MRI and PET/CT
✓ Most comprehensive evaluation
✓ Recommended if PSA significantly elevated
✓ Gives complete picture of recurrence location
✓ Cost: $3,000-5,000

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Step 3: Interpretation of Imaging
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If Imaging is NEGATIVE (No Recurrence Found):
✓ PSA elevation was likely benign
✓ Continue routine surveillance
✓ Repeat PSA in 3 months (closer monitoring)
✓ Repeat imaging in 6-12 months if PSA continues rising
✓ No treatment needed

If Imaging Shows LOCAL RECURRENCE (in pelvis):
⚠️ Cancer has returned in the area where prostate was
⚠️ Treatment options:
   • Salvage radiation therapy (most common)
   • Hormone therapy
   • Combination approach
⚠️ Your oncologist will discuss options with you

If Imaging Shows METASTATIC DISEASE (distant spread):
🔴 Cancer has spread beyond the pelvis
🔴 Treatment options:
   • Hormone therapy (androgen deprivation therapy)
   • Chemotherapy
   • Combination approaches
   • Clinical trials
🔴 Your oncologist will discuss options with you

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QUESTIONS TO ASK IF YOUR PSA IS >0.020 ng/mL:

Immediate Questions:
1. "Is this elevation concerning?"
2. "Could this be a lab error?"
3. "Should we repeat the PSA test?"
4. "When should we repeat it?"
5. "What could cause this elevation?"

If Elevation is Confirmed:
6. "What imaging do you recommend?"
7. "How soon should we do imaging?"
8. "What are we looking for on imaging?"
9. "What does biochemical recurrence mean?"
10. "What are my treatment options if recurrence is found?"

About Your Surveillance:
11. "How often should I have PSA tests now?"
12. "What PSA level would trigger treatment?"
13. "What symptoms should I watch for?"
14. "Should I make any lifestyle changes?"
15. "Are there clinical trials I should consider?"

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IMPORTANT: DON'T PANIC IF PSA >0.020 ng/mL

Remember:
✓ This is UNLIKELY based on your history
✓ Even if it happens, it doesn't automatically mean cancer
✓ Your oncologist has a systematic approach to evaluate it
✓ Most elevated PSAs have benign explanations
✓ You have treatment options if recurrence is confirmed
✓ Early detection (at PSA level) is the BEST outcome
✓ You're doing everything right by getting tested

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YOUR COMPLETE SURVEILLANCE TIMELINE & EXPECTATIONS

YOUR POST-RARP SURVEILLANCE PLAN:

[date removed]: PSA Test #1
├─ Expected Result: ≤0.010 ng/mL (