The definition of SECOND biochemical recurrence (after prostatectomy AND salvage radiation)

[Tall_Allen]

While there is a standard definition of biochemical recurrence (BCR) after prostatectomy (i.e., confirmed PSA ≥ 0.2 ng/ml), there is a confusing array of definitions of biochemical recurrence (BCR) after salvage radiation (SRT). I'm not sure that we're ready for a standardized definition yet. And perhaps the definition of the FIRST BCR bears scrutiny.

pcnrv.blogspot.com/2019/08/...

[tallguy2]

Thanks for posting this.

[GreenStreet]

Thanks for posting. I am not sure how this works with ultra sensitive PSA testing. I have had RP and SRT yo prostate bed only combined with 6 months of Zoladex with some upfront Casodex to stop flare. PSA went down post SRT and post Zoladex to less than 0.01, then eventually it rose to 0.02 and recently 3 months later to 0.03. I am told that I have biochemical reoccurrence and I have accepted this though I am gutted by it (obviously!). Now being monitored every 3 months with a view to Gallium PMSA test in future when PSA rises to c 0.2 to 0.5 depending on doubling time. I think I saw some data from a Retrospective Swedish study that suggested that 0.03 was a good cut off for deciding on SRT in other words very little risk of overtreatment if you were at 0.03 or over. Difficult territory this!

GreenStreet

[Tall_Allen in reply to GreenStreet]

If you have already had SRT, there is no reason to have an ultrasensitive PSA. It only causes anxiety, and there is absolutely nothing you can or should do while PSA is below 0.1 ng/ml. I think you will feel better if you switch to a conventional PSA test.

[GreenStreet]

You are probably right but I know what my ultra sensitive score is now and the place where I was treated in the UK now does them as a routine. Previously they only measured from 0.04 and anything below was non detectable but recently they changed without telling anyone and so the first I knew about it was when I was presented with my first score which was ok. It is also difficult to know whether the doubling time works the same at such low levels and with the roundings issue. I guess it does.

[Tall_Allen]

It does not.

[Grahammd]

I'm not sure i only had a prostatectomy and no radiation. I am fine now discharged from the hospital only need 6monthly psa at doctors

[j-o-h-n in reply to Grahammd]

Your first and only post was 3 years ago.... Are you trying to ask a question? I see you're in the UK so tell us more about yourself and if you wish ask a question. Post on a future date, not today and not to me.... (don't be shy) Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 08/16/2019 4:58 PM DST

[Jeff85705]

Tall_Allen, what confuses me is all the PSA readings I see here, including out to 3 places past the decimal! How can a PSA test be THAT accurate?! There are so many variables in measurement, including human error and differences between labs. My lab (Labcorp) just reports </= 0.1. Yet I see men claiming 0.008, etc. What gives here?

[Tall_Allen in reply to Jeff85705]

I briefly had a job developing immunoassays to detect nanogram quantities of some biomarkers, so I know something about this. Yes, the ultrasupersensitive PSA tests are sensitive enough to detect the third decimal place (one-thousandth of a milligram per ml). The question is - to what purpose?

[Jeff85705 in reply to Tall_Allen]

That's what I'd like to know. Men are getting upset when their PSA "jumps" from 0.005 to 0.008. Tests may be "ultra-sensitive" but can they be dependable and useful at that level?

[Tall_Allen in reply to Jeff85705]

They are dependable. Useful is a different matter.