bucky24.....I do have a question. There are so many studies with so many conclusions that partly overlap and/or contradict each other that for a neophyte it is hard to determine exactly what is happening. For example, in one of your articles you described a UCLA study that suggested a reading of uPSA of >.03 or =.03 at any time was a virtually 100% accurate predictor of BCR. On the other hand the Koulikov study you referred to in your post quoted above suggests that uPSA of .03 or lower for three years is an almost perfect indicator that BCR will not occur................
The Koulikov study Allen referenced used a cutoff point of >.03, not =.03. Also, the study is based on PSA readings for the first three years after RP. The conclusion is that PSA readings of .03 or less for every reading in the first three years after RP predict a very small chance of BCR. My PSA never rose above .01 on any reading during the first three years, so people with my history would definitely have been in the "undetectable PSA group". On the other hand the UCLA study I mentioned suggests any reading at any time of .03 or higher predicts BCR with perfect accuracy. Maybe I am reading all this wrong, but it appears that for my history, the two studies give completely contradictory results................
Bucky, that is the conundrum isn't it, what/who do you believe? I've grown so cynical over the years it's bordering on the ridiculous but it has certainly made me more pragmatic. They were certainly right when they coined the phrase "don't believe everything you read". Just as important "don't always believe what you want to hear". But I think you already know that. Just some more random thoughts!
Bucky, all I can say is "welcome to the world of contradictory studies and contradictory advice based on them!". WhoooHooo! There have been quite a few discussions around here lately regarding contradictory studies. It makes me question: once we finally get the RCTs on all these different approaches that may or may not help, well, can or do different RCTs ever contradict? If they do, then who the heck are we going to believe?
But if I am understanding your situation: In March of 09, you got your 1st increase from <.01 to an actual .01. Then, for the past 6 years you have oscillated from = to .01 to <.01, up and down over the years.
So though the readings have varied from below .01 to = to .01 all these years, whatever benign or malignant G6 ( or possibly a bit of G7/tertiary?) tissue that was left behind has finally managed to reach that worrisome figure of = to .03?
Like you said, by one study you should never BCR, by another you probably will BCR? You could try to guess which study had the most patients most resembling you.
Seems to me you just don't know. Which study do you prefer?
I don't know, it's hard to figure out, is it not? It can be so frustrating, that as you can see from Doug's post, it has driven him to cynicism! I'd just say try not to worry and wait and see what those future PSAs are going to do. It has taken them a long time to claw their way back up to .03, plus many times in the past they have turned around and headed south again. Seems to me hard to say they won't do the same thing again.
Just think back to over 6 years ago. With that G6 and PSA 5.8/T1C, today you might be even a bit more likely to choose AS, though I guess that tertiary 7 confuses things a bit. But there is another thread right now about
new outlooks on even G7s and AS I believe. Still, if a person with your stats was just starting, you might well choose AS and that is with the knowledge of the full tumor load being present- enough to(along with healthy prostate tissue) run your PSAs up to 200 times higher than it is right now. Well, aren't you kind of in the same position as you were then? I.E. a possible AS but starting with a tumor load that was reduced to almost zero 6 years ago?
So maybe just consider yourself AS until significantly more evidence is available?
PSA 10.9 ~112013
Bx on 112013 at age 64 yrs 11 months, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, but SV+, still G9 but down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
Foley out 030314
PSA <.1 on 4/7
PSA <.01 on 6/11 + 8/20/14