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11 anniversaries since diagnosis of stage 4 prostate cancer
Prostate Cancer | Last Active: 2 days ago | Replies (83)Comment receiving replies
Here's a study (pretty old now) challenging the then-accepted 0.2 PSA as the threshold for recurrence, and identifying < 0.03 uPSA (ultrasensitive PSA) as the most-reliable predictor. It focused only on patients who'd had radical prostatectomies, so it's not necessarily fully-applicable to people who had only radiation and/or ADT and/or ARSI:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527538/That doesn't mean that if your PSA rises back to 0.1 after treatment bad things are happening; just that best practice would be to start monitoring you more closely sooner, BEFORE the PSA climbs to 0.2.
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Thanks for the reply and article. Yes the article does seem to refer to the days when surgery is the treatment of choice, if not the only available treatment. So when the prostate is removed, the docs then, and some now would insist that is it. No more cancer. Except that was not it. So the study tried to determine at what PSA level is the surgery safe. Today, practically no doc will say that PSA over 0.2 is good enough, for surgery, radio. hormonal, chemo or any combination. The issue is also between focal and systemic treatment. Surgery and radio are focal, ie they only deal with cancer in one area which is identified by scanning. Systemic seeks to destroy the cancer cell where ever the medication to get to.
So some docs now would prescribe ADT or chemo after surgery or radio to make sure. That begs the question. Why bother with treatments when still have to rely on systemic anyway? The answer for Dr. Scholz is simply does not do surgery.
Those were the good old days. Now we have ultra sensitve PSA < 0.003, and PSMA PET scan. Are we looking at totally different scenarios?
Sorry to get long winded again. I am just another layman trying to make some sense of the whole thing. At first, it seems straight forward enough. But soon as you think you understood something, there is another area you did not see before. What the heck?