Every now and then there are discussion about
the theoretical level of ultra-sensitive tests after surgery and when these should trigger salvage therapy such as EBRT (External Beam Radiation Treatment) or ADT (Androgen Deprivation Therapy).
There are many views on this matter and some of them are illustrated in the latest update from Yana contributor which you can read at Doug Harvey
Briefly a rising PSA which hit 0.29 ng/ml triggered a decision by his medical advisor that he should have EBRT He went for a second opinion at another institution where they had differing criteria for commencing EBRT after surgery.
He had a number of PSA tests during this process, none of which agreed, but which had a range from 0.29 ng/ml to 0.03 ng/ml – Oh! and his Gleason Score, which had been upgraded from 3+4=7 to 4+3=7 after his surgery was downgraded back to 3+4=7 – that was good news, but his post operative staging was also changed from pT2c to pT3a
This is anecdotal and dismissed by many for that reason but I believe it illustrates a number of points, the main ones being the lack of agreement between experts and the lack of accuracy in PSA tests - something that newbies are often not fully briefed on.
Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony Metastasis: Aug '07: Intermittent ADT: PSA 2.3 Aug '10
It is a tragedy of the world that no one knows what he doesn’t know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey