alephnull said...
Just an FYI,
PSA readings only matter when it rises just above 0.1, as most treatments typically don't happen until even higher than that. At least that's what it's been for me.
There are exceptions for high-risk men with adverse path features. Some escape adjuvant treatment after healing, but want, or are advised, to start adjuvant or very early salvage treatment below 0.1. ROs seem to be evenly split into two camps, those aligned more with uros, who usually advise a higher PSA to start treatment, and the other half, who are advocating for much earlier treatment. This is a very active research topic, and more results are due out this year. What is known is that (1) far too few men are taking advantage of adjuvant therapy when it is advised (i.e., based on RP findings and an even undetectable post-op PSA). And (2) perhaps as many as 40% of men who get SRT are (necessarily) over-treated (i.e., would not go on to clinical recurrent disease from their BCR) -- few want to risk mPCa.
I am high-risk but with a current stable PSA of 0.015. On the one hand, I have no intention of rushing into salvage treatment (especially not knowing the
location(s) of any BCR). On the other I doubt I would wait to a PSA of anywhere approaching 0.1 before starting treatment. My uro says he gets enough BCR "lead time" with his in-practice PSA test that detects down to 0.05, but had no problem when I asked to be followed with Labcorps uPSA test.
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uPSA serves other purposes. For example, the post-op PSA nadir has been shown to be a good predictor of BCR risk. A nadir of <0.03 is good; <0.01 even better.
The time from nadir to the start of BCR, as well as the rate of climb (velocity), can provide addition data. With the traditional test (<.1) used for men with prostates, you miss out on your nadir entirely. Labcorp describes its ultrasensitive test as the one appropriate for post-prostatectomy PSA monitoring. Walsh, in the 4th ed. of his book, seems to agree.
Djin