This thread started out with a rather simple question: After radical prostatectomy, when do ultrasensitive PSA [uPSA] scores require action. I had this same question before my last appointment.
Background information I think I've correctly understood:
1) Historically, PSA post RALP was not considered actionable until it reached 2 [ng/ml.]. However, this was when PSA was reported as >1, 1,2,etc., so this only meant it was measurable (reached 1) and rising (reached 2).
2) Biochemical recurrence is defined as PSA >0.2 using a typical uPSA.
3) With ultrasensitive PSA, some research centers believe it to be actionable as low as 0.03. (Notice we've now dropped almost two levels of magnitude from 2.)
4) My urologist told me, if I understood correctly, he believes we should act [in my case] when it reaches 1.0. (Since I'm always a bit emotionally aroused in these discussions, could it have been 0.1? I don't think so, but....)
5) There is always someone somewhere who will prescribe more diagnostics or more treatment whatever our scores are.
6) All of us with prostate cancer [PC] diagnoses are prone to some level of anxiety regarding recurrence.
Why? Prying minds want to know, especially PC minds (with no reference to political correctness.)
As I understand it, the tradeoff is between overtreatment, just in time treatment, and too late treatment.
-Unfortunately the goal is never to eradicate the PC. Rather it is to delay its progress in the killing journey.
-Overtreatment is not only expensive, sometimes 100s or 1000s of times as expensive, but it runs the risk of using tools too soon, with some possibility they will not be available or as effective when they should be used. It also lowers quality of life (incontinence, erectile dysfunction, muscle mass, hormones, etc.)
-Just in time treatment is hard to identify because there is always more cancer there than any tool can measure, but every tool at its limits has "maybe" as the answer.
-Too late treatment is only evident when people die earlier than necessary, but even with too late treatment PC typically kills between 10 and 20 years, making good evidence hard to come by. uPSA testing has only been around for maybe 25 years? How long has it been commonly measured? (I think some studies have gone back and re-assayed old samples using uPSA methods.)
Anyway, it turned out my uPSA scores were in 0.01x range and the third was as low as the first, so "my time has not yet come." Still, if the third had been higher than the second, instead of back down to where the first was, I would have worried. AND I will now make a point of testing about the same time of day, although I don't think biking or sex are likely to have much effect in my post-prostate world....
Please, corrections are most welcome!