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@northoftheborder

I'm still looking, but I haven't found any literature yet about cases of regular advanced prostate cancer progressing without expressing PSA on the ultrasensitive test (< 0.01).

I've seen a couple about progression when PSA was < 0.5 (the lowest early tests could detect), and a fair number when PSA was detectable in the low range (< 5.0).

That's one reason they often use uPSA to give early warning of recurrence for metastatic prostate cancer.

Note that there's a different, rarer type of prostate cancer, neuroendocrine, that does not express PSA as it spreads, but the adenocarcinoma that most of us have does.

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Replies to "I'm still looking, but I haven't found any literature yet about cases of regular advanced prostate..."

Ah, to chime in with the variant - we had uPSA tests (if that means to the 2-3 decimal)s. Last results:
11/1/2022 0.144
5/31/2023 0.199
11/30/2023 0.198
6/14/2024 0.323
8/13/2024 0.368
11/11/2024 0.430
1/7/2025 0.370
And PET 1/30/25 turned up 3 spots on lung. Bronchoscopy 3/10 and needle biopsy 4/3 confirmed adenocarcinoma of prostate origin. Liquid biopsy cTCs < 1 with low tumor burden. Relying on waiting til PSA gets to .5 or 1.0-2.0 seems too late!