Phil
That approach is why Im in this clinical trial at NIH (NCT05588128) w Dr Ravi Madan. He's looking for volunteers.

Might want to help get the word around.

NIH covers travel expenses of us "lab rats". Plus it's first rate detection and follow up w all results sent to your attending docs who remain the lead dogs on the sled.

Dr. Ravi Madan is leading a clinical trial to determine the natural history of prostate cancer recurrence in patients with very low PSA levels that are detectable with sensitive PSMA scans. The core question of the trial, and the answer to your query, is: Just because a sensitive PSMA scan can now detect recurrence at very low PSA levels, does that mean we should immediately treat it? The current consensus is often no, and the study aims to definitively answer this question.
The clinical trial and its implications
Study design: Dr. Madan's trial (NCT05588128), conducted at the National Cancer Institute, monitors patients with biochemically recurrent prostate cancer (a rising PSA after initial treatment) using repeated PSMA PET imaging, along with regular PSA tests and biomarker collection.
Understanding the disease's "natural history": The primary purpose is to follow patients without immediate intervention to see how the disease progresses over time. PSMA scans can show tiny spots of cancer earlier than ever before, but it's not known if these micrometastases represent an immediate threat to the patient's health.
Challenging the impulse to treat: Previously, conventional imaging like CT and bone scans were far less sensitive, so visible recurrence was treated. Now, very sensitive PSMA scans can create anxiety by revealing tiny spots of cancer that may be clinically insignificant and progress very slowly. The trial questions whether this finding necessitates immediate, aggressive therapy.
Early findings: Preliminary results presented at ASCO 2024 showed that of 86 patients monitored, 76 had PSMA-positive findings, but only one progressed in the short term, with 85% receiving no treatment. This early data suggests that many patients with PSMA-detected recurrence can be safely monitored without rushing to therapy.
Preserving quality of life: A major goal of this research is to delay the need for systemic treatments like Androgen Deprivation Therapy (ADT), which can cause significant side effects and reduce quality of life. The trial seeks to find low-toxicity alternatives or determine that surveillance is the better option for some patients.
PSA doubling time remains important: The study reinforces that PSA kinetics—specifically, the rate at which PSA levels are rising (PSA doubling time)—are still a crucial indicator for risk stratification and may be more important than a single positive PSMA scan.
Conclusion: A change in approach is likely needed
The research by Dr. Madan and others suggests that simply seeing a spot of cancer on a PSMA scan at very low PSA levels does not automatically mean treatment is necessary. The high sensitivity of PSMA imaging requires a new understanding of what "recurrence" means in this context. The findings from this trial will help develop new, evidence-based guidelines for managing patients with PSMA-detected recurrence, potentially allowing for active surveillance in certain cases and avoiding or delaying unnecessary toxicity from treatment.