Great article Richard! I thought I would highlight this particular point. The question of PSA recurrence often comes up in here and this study quotes the AUA.
Definition of Primary PSA Recurrence
The goal of radical prostatectomy (RP) is to remove the entire prostate. Therefore, slight rises in PSA are used to indicate cancer recurrence, although the exact level that defines PSA recurrence is debatable. In general, PSA levels > 0.4 ng/mL or > 0.2 ng/mL are used in most studies. Recently, the American Urological Association published guidelines that establish the consensus definition of PSA recurrence after RP to be greater than 0.2 ng/mL and rising, as confirmed on a repeat test. This definition is to establish recurrence for outcomes reporting; however, it may not be the appropriate cutpoint to initiate therapy.
Indeed, it is our practice in a patient with a consistent and clearly rising PSA, often based on ultrasensitive values, to occasionally begin salvage radiotherapy when the PSA is between 0.1 and 0.2 ng/mL. Because microscopic or focal benign prostate tissue can sometimes be left behind after RP and may produce some small amounts of PSA, it is clinically important to recognize that a PSA of 0.2 ng/mL may not always represent cancer recurrence. Therefore, in the majority of patients, we do wait until the PSA is > 0.2 ng/mL before beginning salvage treatments.