It's a chart I created to provide a quick visual image of my clinical history, useful when new members of my medical team and I meet for the first time, or providing my clinical history on this or other forums, a picture is worth a thousand words...

After my surgery, PSA was undetectable using standard tests to a single decimal point every three months,. Then in September 2015, Dr. Emmott hesitated before turning away from his screen and said your PSA is .2, it doesn't mean your PCa is back. He was not wrong, but I knew. In December, roughly 90 days later, he turned quicker and said your PSA has risen to .3, you need SRT...I started that in March 16, 39 IMRT, 70.2 Gya. It was in July 16, 90 days after finishing my SRT that my radiologist hesitated after looking at her screen and said your PSA is now .7, the SRT did not work.

If one has decided to image, then decide on treatment, ADT is definitely off the table.

My take is it's not that the PSMA imaging cannot detect at levels below .5, it is the issue of statistically less chance of locating it then depending on one's insurance, may run into difficulties getting the next one above .5 "approved." Same for imaging while on treatment, my oncologist was hesitant to order one with PSA undetectable fo concerns about approval. That happened with one of my four C11 Choline scans at Mayo, TRICARE denied, Mayo said I was on the hook for it, I appealed and won, cited the NCCN guidelines. Thus the questions, will waiting change the treatment plan and does it entail progression that has risk to management of the PCa?

It's an interesting discussion about "killing" PCa cells vice suppressing, we generally agree that radiation and chemotherapy kill, ADT suppresses though given the drop in PSA with ADT, don't some of the PCA cells die...? We know that the longer one is on ADT, the cells which can survive in a low T environment are generally the minority population in the heterogenous mix but as the T dependent cells "die" off, the T "independent" cells move to the forefront and can become the dominate ones, then it's trouble.

I've seen studies which talk to different grade of toxicities associated with radiation treatment, usually in the context of 5-10 years. Statistically, the chances are in your favor...there is a statistical chance that when I leave my house to go to the grocery store, I will be involved in an accident, albeit a manageable risk. My dad hated flying, I said ok, but you have a greater chance getting in an accident on the way to or from the airport, so...

Kevin