I know your post was a couple years ago but I'll throw in my $0.25 worth for those finding this thread.

I was diagnosed 20 months ago and had a robotic prostatectomy 16 months ago. I'd say I spent, conservatively, 200 hrs reading everything I could about the disease and its treatment.

There are too many studies for me to list as I have learned to get on with my life and stop obsessing over whether my cancer is coming back and what I will do about it. But I can give you my personal summary based on a lot of reading of studies released all the way into 2022.

There are dozens of studies regarding short and long-term outcomes post-prostatectomy related to Ultra Sensitive PSA tests. Some studies use a 0.01 cutoff, others 0.03, some 0.04, and of course there's the more traditional non-ultrasensitice cutoff of 0.2. My opinion coincides with what most Centers of Excellence have chosen as the best cutoff point which is 0.02. The reason being is results below that are too unreliable for predicting with a high degree of certainty whether you are having biochemical recurrence or not without risking overtreatment.

So at two different Center of Excellence (at University and a regional medical center) my PSA result comes back "< 0.02" and I don't know what the actual number is. Because if it's less than 0.02 it's not actionable and is just going to cause a cancer survivor undue stress watching their number climb or bounce around at levels < 0.02 levels.

My understanding is current practice for the top Urologists who keep abreast of all the studies and treatments is that they will not recommend considering salvage treatment until you have two consecutive readings that are rising and above 0.03. The effectiveness of salvage therapy goes down the higher your PSA rises. The average PSA these days in at least one study for salvage therapy was 0.08. Far lower than the 0.2-0.5 range it occurred at in many years past. It's because the outcome is better the sooner you do it but you only want to do it if your PSA has risen to a level that has been statistically proven to reliably predict BCR. Probably a lot of patients hit 0.04 to 0.08 when they decide to get salvage therapy and by the time they get into the treatment clinic their PSA is at 0.06 - 0.12 or so hence the 0.08 average.

So in a nutshell, in my opinion, if your PSA is < 0.02 you have nothing to worry about or discuss with your doctor. You can still ask to put your mind at ease. I don't even have a Urologist anymore since I moved to another state so only my primary care physician is seeing my PSA results every 3 months and she has no clue about what to do when, as prostate cancer is not her speciality of course. I'm not going to get on a plane or in a car or schedule a teleconference with a Urologist at UCLA or UCSF until I see my PSA go above 0.03. Hopefully that will never happen. Anything lower than that, even at 0.025, and all the Urologist is going to do is say let's wait and see what your next test result is 3 months from now. I can do that on my own!

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