Is the risk of BCR 50% for post RP guys with a uPSA of 0.01 as this study suggests?

[jronne]

figure summarizes this

ncbi.nlm.nih.gov/pmc/articl...

from the uPSA 0.03 BCR Kang study

ncbi.nlm.nih.gov/pubmed/254...

PURPOSE:

Integrating ultrasensitive prostate specific antigen with surveillance in patients at high risk after radical prostatectomy potentially optimizes treatment by correctly identifying recurrence, promoting an early salvage strategy and minimizing overtreatment. We tested the power of postoperative ultrasensitive prostate specific antigen to identify eventual biochemical failure.

MATERIALS AND METHODS:

We identified 247 patients at high risk with a median followup of 44 months who underwent radical prostatectomy from 1991 to 2013. Each patient had extraprostatic extension and/or a positive margin. Surgical technique, initial prostate specific antigen, pathology findings and postoperative prostate specific antigen were analyzed. The ultrasensitive prostate specific antigen assay threshold was 0.01 ng/ml. Conventional biochemical relapse was defined as prostate specific antigen 0.2 ng/ml or greater. Kaplan-Meier and Cox multivariate analyses were done to compare the rates of ultrasensitive prostate specific antigen recurrence and conventional biochemical relapse.

RESULTS:

Sensitivity analysis revealed that ultrasensitive prostate specific antigen 0.03 ng/ml or greater was the optimal threshold to identify recurrence. A first postoperative ultrasensitive value of 0.03 ng/ml or greater, Gleason grade, T stage, initial prostate specific antigen and margin status predicted conventional biochemical relapse. On multivariate analysis only a first postoperative ultrasensitive value of 0.03 ng/ml or greater, Gleason grade and T stage independently predicted conventional biochemical relapse. First postoperative ultrasensitive prostate specific antigen 0.03 ng/ml or greater conferred the highest risk (HR 8.5, p < 0.0001) and identified conventional biochemical relapse with greater sensitivity than undetectable first conventional prostate specific antigen (70% vs 46%). Any postoperative prostate specific antigen 0.03 ng/ml or greater captured all failures missed by the first postoperative value (100% sensitivity) with accuracy (96% specificity). Defining failure at an ultrasensitive value of 0.03 ng/ml or greater yielded a median lead time advantage of 18 months (mean 24) over the conventional definition of prostate specific antigen 0.2 ng/ml or greater.

CONCLUSIONS:

Ultrasensitive prostate specific antigen 0.03 ng/ml or greater is an independent factor that identifies biochemical relapse more accurately than any traditional risk factors and confers a significant lead time advantage. This factor enables critical decisions on the timing of and indication for postoperative radiotherapy in patients at high risk after radical prostatectomy.

60 years old

Decipher score 0.22 low risk

11/15 RP UCSF Dr. Carroll

pT2a pN0, invasion into capsule, EPE-, LVI-, PNI+

3+4 Gleason7 30% 4

10% tumor 1.2 cc

PSA 5.0 9/28/2015 (free PSA 8%)

12/27/19 12/20/19 12/13/19

0.011 0.010 0.012

7/19 4/19 11/18 9/18

<0.006 0.008 0.009 0.007

7/18 4/18 2/18 1/18 11/17

0.007 <0.006 <0.006 0.008 <0.006

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From what I've read, combined germline and somatic BRCA2 mutations are around 25% of patients who have CRPC.

[tango65]

I believe your PSA is stable since 2017 at value of 0.01 if you round the numbers. It went from 0.006 (0.01) in 11/17 to 0.011 (0.01) on 12/27/2019.

[jronne in reply to tango65]

tango65 thx for your take

I would be clueless if the uPSA test had remained at a sensitivity of < 0.015 as I got my first celebration of < 0.006 on 6/17 immediately followed by a sucky 0.009 on 9/17

just trying to connect with others that are in my spot

I cannot be the only guy with a consistently low uPSA that might be rising ?

supplements btw can play a role in artificially suppressing PSA with by masking it without slowing cancerous activity

turmeric should likely be stopped days in advance of a uPSA test

pcnrv.blogspot.com/2019/04/...