@heavyphil In one of Dr. Kwon’s other videos, he says “If you can find it, you can fight it!” That’s probably key in “treating it earlier rather than later.”

I typically see references to doctors waiting until PSA hits 0.4 ng/mL before following up with a PSMA PET scan; at least then there’s a 50/50 chance of seeing a lesion. The risk with going in early (& blindly) is that radiation damages healthy tissue; the risk with going in late is that the cancer might be aggressive (which is why frequent PSA testing would be necessary if waiting.)

Earlier is better, but a false negative with a very expensive test is problematic. (That may also be why Mayo Clinic is said to follow a negative PSMA PET scan with a Choline C11 PET scan, which isn’t dependent on PSMA.)

I suspect that there wouldn’t be much difference in “lighting up like a Christmas tree” when comparing PSAs of 0.2 ng/ml to one of 0.4 ng/ml.

(If I should have a recurrence, the technical definition of biochemical recurrence following initial radiation - a PSA rise of 2.0 ng/mL above nadir (called the Phoenix Criteria) - was established in 2005 (20 years ago!) when modern imaging techniques (like PSMA-PET scans) that can detect recurrence at lower PSA levels were not available. It’s now known that BCR can occur following initial radiation well before that “2 points over nadir” threshold is reached. The Phoenix Criteria served its purpose well - to differentiate true cancer recurrence from PSA fluctuations in order to prevent overtreatment, but is now likely outdated, with today’s earlier and more effective diagnostic techniques.)