oncolink.org/oncolink-libra....
One school seems to maintain that PSA below 1, or 0.5 and less than 0.2 is disease free. The reason is that with the prostate intact, there is bound to be some PSA.
Another school insists that PSA should fall below 0.1 as that would indicate there is no cancer cells remaining.
Any thoughts?
A low nadir is associated with being disease-free long term. It is not a guarantee of "disease-free."
But if you are taking ADT, which always lowers PSA while it is effective, there is no such association.
Also, nadir without ADT is rarely achieved in 6 months.
Thanks for reply. The confusion is one of terminology/concept perhaps. The article refers to study in 2001 (?) which indicates that 92 % those achieve 0.2 or below had non rising PSA after 10 years. That seems to mean to a layman PFS? BFS? whatever the pros call it.
On the other hand, there some doctors seem to suggest for PSA above 0.1, the cancer cells remaining, if there is indeed cancer may be more aggressive, or indicative of early resistance etc.
The two opinions though not 100% opposed, are somewhat hard to reconcile.
While we have official published findings of the first study, there seems to be none of the second.
Do you or anyone know of any, and if so can we please have the link?
You are confusing PSA after prostatectomy with PSA after RT.
Never mind but thanks anyway.
For the last 24 months my PSA is < 0.04. Only Take Dutasteride and finasteride. Am I decease free?
No, you have no biochemical progression at the present time.
Does it matter that I have an untreated prostate ?
Thank you.
No. It's a definition.
So the demon is still hiding in the shadows.
Nadir PSA at 0.06 is a strong independent predictor of BFS in patients with intermediate or high risk prostate cancer treated by definitive EBRT and ADT.
Forty seven patients (12.5%) developed biochemical recurrence (BCR) during the observation period. Monovariate analysis identified baseline PSA (bPSA) (p = 0.024), T-stage (p = 0.001), Gleason’s score (GS) (p = 0.042), radiation dose (p = 0.045), PSA pre-radiation therapy (p = 0.048), and nadir PSA (nPSA), (p < 0.001) as significant variables affecting BCR. The receiver operating characteristic (ROC) curve identified a nPSA of 0.06 ng/ml as optimal cut-off value significantly predicting the patients’ risk of BCR (p < 0.001). Multivariate cox regression analysis revealed T-stage, GS, and nPSA as independent variable affecting BFS, while bPSA, age, and radiation dose were not.
You can never be certain you are free of the cancer.
It can take years for the PSA to settle.
All you can do is wait until you see it on a doubling trajectory.
Probably best not to obsess about it too much.
After talking to my RO:
Psa 30 ..diagonized T3BN0M1 june 2019
Had RT in nov 2019 and ADT for 3 years..
off ADT since march 2022... psa <0.04 since jan 2020
RT says that gradually psa may reach 2
as prostate is there with its cells.
There is a link with testoterone which will go up as well...PSA follws similar growth cutve..
No known marker for. being cancer free..
just live fully...diet exercise meditation
intermittent fasting Love and anger free 16/8/3
age 82 plus...
Thinking of elderly homeless after hurricane in Florida..
I have also wondered about PSA levels if you still have your prostate. A healthy (non-cancerous) guy in his 60's should have a PSA of between 1 and 4 so if I were to be lucky enough to defeat my PCa, surely my PSA should settle back within that range eventually?
very good point. I’m thinking 2.0 is the threshold to the advancement of the 4.0 after 3-4 months as what MO as doubling.
I’m 7 months in drug free and sitting at 0.174 at present. 3 month testing is the plan. If I hit the 2.0 after 2 years drug free I will pay particular attention as this may be the alarm as cells multiplying. As for now eating a balanced meal, exercise and a healthy mental attitude with my own personal prayer and praise music that benefits me personally. To each their own.
Reply to both. Indeed. The presumption seems that if PSA is above 0.1, there must be some cancer. The study cited suggests that even if there is for 93% under 0.2, it is progression free after 10 years. So what?
The point about threshold 2.0 is that the most sensitive scan available, MRI, CT, CT/PET etc cannot locate the cancer if it is present below that. At least that is what some doctors say. And if you cannot find it, you cannot do anything about it. That is why doctors will set the threshold.
So we have this no man's land between 0.1 and 2. Some doctors insist there must be some bad cancer, but they cannot find it, and therefore cannot do anything other than wait to see if it goes above. Others say dont worry.
That seems to be where we stand at this time. Any thoughts?
This is we’re a possibility in a micro dose of Xtandi for example. 20mg ? That’s if it still works. Why all or none when on a vacation? If one is undetectable for 6 months why cold turkey but take a micro dose enough to keep cancer at bay with little or no issues. Just seems logical to a degree in my mind. Anyone done a test on that thinking? Guess the negative would be bone weakness…. don’t know.
I take one seventh of the usual Bicalutamide dose (50mg/week) by which my PSA is maintained within the desired range.
Indeed. That seems reasonable and relatively low cost solution. But for now, it seems the preferred prescription is ADT shot every 3 or 6 months.
My thought was nothing about cost or more Injections but one of the lucky/blessed ones who can hit undetectable for 6 months after the normal ADT treatment with a drug like Xtandi and as the other poster mentioned Bicalutamide. After 6 months of undetectable from whatever treatment the doctor suggests then when that doctor says time for a vacation not going completely off the xtandi or Bicalutamide but a micro dose of those drugs. This slowing the PSA rise from the partial vacation as will a 85% reduction in all the misery that we endure from the injections and full doses or half dose of xtandi and Bicalutamide. I call it buying insurance so the PSA doesn’t rise as fast when a complete vacation is involved. I’m no doctor but just thinking outside the box and seems logical also.
I say you need to add 5 years to that formula.
And if you have any metastasis whatsoever, you will never attain cure statis. Ever.
PSA after RT seems to be different for each of us…Diagnosis in 2005 and had 8 wks of radiation…My PSA then was 6.9 with gl 6. For years my PSA was around 1.0 …Two years ago my PSA was increasing…I had a Biopsy in and MRI , they showed some cores with intraductal carcinoma with GL 6 and 7…and PSA is 1.58 (on 6/21). PSMA showed cancer was confined to prostate. From Oct ‘21 to March ‘22 i had monthly shots of firmagon…PSA was .444 in September. RO wants to check in December. I haven’t had any salvage treatment…
Let's see if this is a fair summary?
With treatment other than removal of prostate, whether RT, ADT etc, the BPF or non rising PSA after 10 years is 92 %. That is established and published in medical journal. It is considered a good outcome because with the prostate intact, there is bound to be some PSA. Whether that is indication of cancer cannot be determined.
Further, 50% of male over the age of 60 who is not diagnosed of prostate cancer are found to have some cancer cells.
However, since then, some doctors observe a better outcome is PSA 0.1 or lower. That may be achieved in 6 months or longer. The reason being that is the only proof that there is no cancer in the body. Any confirmatory study remains to be located.
In either case, the PSA may fluctuate or not. It may rise up to 2.0 before any treatment is called for. The reason is that with the best or most sensitive scan available today, we cannot locate all the cancerous tissues. You cannot treat what you cannot see. Also PSA 2.0 is considered 'normal'.
Fair?
See Dr. Juanita Crook's paper defining cure after brachytherapy. pubmed.ncbi.nlm.nih.gov/324.... PSA Nadir <= 0.2 at 4 years after therapy suggests cure. This formula may not apply to men who had external beam radiation without high biological dose with brachytherapy boost or maybe SBRT.
You have to have recovered testosterone to normal levels before you can trust your PSA numbers.
Thanks for the link. The study seems to establish PSA under 0.2 as threshold for long term cure or disease free, as opposed to 0.1. It is significant for anyone under treatment, whether by LDR, or ADT, or both as stated in the study.
4 Months ADT or 6 months. 
Help on what to expect with this 6 month follow up? 
6 months in and ADT already failing
ADT Vacation/What PSA to Resume and Prostate Cancer Bipolar Therapy With Testosterone
considering stopping adt/abiraterone to see what happens
