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Your Monitoring Plan: Next Steps

Recommended Follow-Up Schedule

According to NCCN Guidelines (2025), AUA Guidelines (2023), and EAU Guidelines (2023):

For favorable intermediate risk patients with undetectable PSA and slight rise:

| Time Point | Recommended Action | Your Status | |---|---|---| | Now (304 days post-op) | PSA = 0.007 ng/mL | ✅ Undetectable, stable | | In 3 months (430 days post-op) | Repeat PSA test | ⏳ CRITICAL TEST | | In 6 months (490 days post-op) | PSA test (if 3-month PSA reassuring) | ⏳ Confirmation test | | Ongoing (Year 2+) | PSA every 3-6 months | ✅ Standard monitoring | | Ongoing (Year 5+) | PSA every 6-12 months | ✅ Long-term surveillance |

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Your 3-Month PSA Test: Why It's Critical

What This Test Will Tell You

Your 3-month PSA test (in approximately 3 months) is the most important test you'll have in the near term.

Why?

According to NCCN Guidelines (2025), AUA Guidelines (2023), and EAU Guidelines (2023):

This test will clarify whether your PSA rise is:

1. Real (concerning) — PSA continues rising
2. Assay variability (reassuring) — PSA drops back down or stays stable
3. Borderline (requires more monitoring) — PSA stays in the 0.004-0.010 range

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Three Possible Scenarios at Your 3-Month Test

Scenario 1: PSA Drops or Stays Low (0.004-0.005 ng/mL)

| Finding | Interpretation | Action | |---|---|---| | PSA = 0.004-0.005 ng/mL | ✅ Reassuring | Return to standard monitoring (every 6 months) | | Meaning | The rise from 0.004 to 0.007 was likely assay variability, not real PSA rise | Continue routine follow-up | | Prognosis | Excellent — no change | 85-90% 5-year BCRFS maintained | | Next action | PSA in 6 months | No imaging needed |

Scenario 2: PSA Continues Rising (0.008-0.015 ng/mL)

| Finding | Interpretation | Action | |---|---|---| | PSA = 0.008-0.015 ng/mL | ⚠️ Concerning trend | Increase monitoring frequency | | Meaning | Real PSA rise confirmed; PSA doubling time is slow but present | PSA every 3 months | | Prognosis | Still excellent, but requires closer watch | 85-90% 5-year BCRFS, but monitor carefully | | Next action | PSA in 3 months; consider imaging if PSA approaches 0.1 ng/mL | Plan for salvage therapy discussion if trend continues |

Scenario 3: PSA Rises Significantly (>0.020 ng/mL)

| Finding | Interpretation | Action | |---|---|---| | PSA >0.020 ng/mL | ⚠️ Rapid rise | Urgent imaging and oncology consultation | | Meaning | Aggressive PSA kinetics; possible early biochemical recurrence | PSMA-PET scan recommended | | Prognosis | Still favorable intermediate risk, but requires treatment planning | Discuss salvage therapy options | | Next action | PSMA-PET scan; oncology consultation within 2-4 weeks | Plan salvage radiation therapy or other options |

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What to Expect at Your 3-Month PSA Test

How to Prepare

According to NCCN Guidelines (2025) and AUA Guidelines (2023):

Before your PSA test:

• ✅ Schedule PSA test at approximately 430 days post-op (3 months from now)
• ✅ Avoid ejaculation for 48 hours before the test (can falsely elevate PSA)
• ✅ Avoid vigorous exercise or cycling for 48 hours before the test
• ✅ Avoid urinary tract procedures for 1 week before the test
• ✅ Have the test done at the same lab if possible (for consistency)
• ✅ Request the same PSA assay (ultra-sensitive PSA test, not standard PSA)

Why these precautions matter:

• PSA can be falsely elevated by ejaculation, exercise, or urinary trauma
• Ultra-sensitive PSA tests are more accurate for detecting very low PSA values
• Same lab and assay ensure consistency in your trend

Source: NCCN Guidelines (2025) — PSA testing protocols; AUA Guidelines (2023) — PSA monitoring after prostatectomy

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Questions to Ask Your Oncologist Before Your 3-Month Test

To Ensure Optimal Monitoring and Planning

1. "Should I have my PSA test done at the same lab using the same ultra-sensitive assay?"

   • ✅ Recommended answer: Yes, for consistency and accuracy
   • ✅ Ask for: Ultra-sensitive PSA (not standard PSA)

2. "What PSA value would trigger imaging (PSMA-PET scan)?"

   • ✅ Standard answer: PSA >0.1 ng/mL or rapidly rising PSA doubling time <3 months
   • ✅ Your current doubling time: ~9-10 months (slow, reassuring)

3. "If my PSA continues to rise slowly, at what point would you recommend salvage therapy?"

   • ✅ Standard answer: When PSA reaches 0.1-0.5 ng/mL with imaging confirmation
   • ✅ Earlier treatment (lower PSA) generally has better outcomes

4. "What is my current PSA doubling time, and how does it compare to other patients?"

   • ✅ Your answer: ~9-10 months (slow/favorable)
   • ✅ Concerning would be: <3 months (aggressive)

5. "If biochemical recurrence is confirmed, what are my salvage therapy options?"

   • ✅ Standard answer: Salvage radiation therapy (most common), salvage hormone therapy, or clinical trials
   • ✅ Ask about: Timing, side effects, success rates

6. "Should I avoid any activities that might affect my PSA level?"

   • ✅ Standard answer: Avoid ejaculation, vigorous exercise, and cycling for 48 hours before testing

7. "How often should I have PSA testing if my 3-month test is reassuring?"

   • ✅ Standard answer: Every 6 months for the next 2-3 years, then annually
   • ✅ If PSA rises: Every 3 months until trend is clarified

Source: NCCN Guidelines (2025) — Patient education and shared decision-making; AUA Guidelines (2023) — Post-operative surveillance protocols

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Long-Term Monitoring Schedule

Years 2-5 and Beyond

According to NCCN Guidelines (2025), AUA Guidelines (2023), and EAU Guidelines (2023):

If your 3-month PSA test is reassuring (PSA ≤0.010 ng/mL):

| Time Period | PSA Frequency | Other Tests | Rationale | |---|---|---|---| | Year 1 (post-op) | Every 3 months | None unless PSA rises | Monitor for early recurrence | | Year 2-3 | Every 3-6 months | None unless PSA rises | Continue close monitoring | | Year 4-5 | Every