I have previously been an advocate for using the ultra-sensitive test, primarily for folks with aggressive PCa trying to determine if they should pursue adjuvant or salvage RT. I base my advocacy on the following article: "Adjuvant Radiotherapy After Prostatectomy: Does Waiting for a Detectable Prostate-Specific Antigen Level Make Sense?,"www.redjournal.org/article/S0360-3016%2810%2903669-2/fulltext
I found the following statement relevant:
Perhaps the most compelling argument is that there are simply no data that compare truly adjuvant RT (with PSA <0.01 ng/mL) vs. salvage RT at the first indication of a measurable PSA level. Interestingly, even though all patients in the ARO trial had pre-RT PSA strictly <0.1 ng/mL (compared with the higher threshold levels of 0.2 ng/mL for the EORTC trial [with 9% of their patients >0.2 ng/mL] and the SWOG trial [with 35% of their patients >0.2 ng/mL]), they achieved equivalent 5-year bNED rates within their 95% confidence intervals (72% vs. 74% vs. 77%, respectively). This supports the hypothesis that, within a narrow “window of opportunity,” successful postoperative RT will be equally accomplished whether PSA is undetectable or whether it is barely detectable. That window of opportunity might be a postoperative PSA level within the range of 0.05–0.1 ng/mL.
Now I realize that many will not find this article sufficiently compelling to overcome their objections to the ultra-sensitive PSA test, or to base a decision about
RT. I, however, have found it useful in my own case, and offer it to those who might find it useful as well.