Further to what I just wrote:

See Shen S, et al., "Ultrasensitive serum prostate specific antigen
nadir accurately predicts the risk of early relapse after radical
prostatectomy."

"Conclusion: Ultrasensitive PSA nadir accurately predicts the risk of
early biochemical relapse following RP. Men who achieve a nadir of less
than 0.01 ng/ml have a low likelihood of early relapse. Higher nadir
points may identify candidates for early adjuvant or salvage therapies."

Pub Med ID: 15711268

For anyone who cares, Pub Med is from the US National center for
Biotechnology Information, not a Tijuana quack clinic. Go to www.pubmed.gov

Regards,

Steve J

I generally disdain writing and reading long prose in this forum.  To those
others that do, I apologize at the start.  But, my brevity has caused
confusion.  When that occurs, I generally drop the discussion in the belief
that it is not important enough to override the above mentioned disdain.
However, in this case I feel I may have also confused one or more newbies
that may or may not be lurking.  That's a bad thing.  So here goes.

PSA TESTING OF THE UNDIAGNOSED

It is my considered opinion that men of 40 should begin annual
ultra-sensitive testing for prostate cancer.  It used to be 50, but part of
that was the ignorance which prevailed with regard to PSA patterns and
relationship to diagnosis of PCa.  Another part of it was the lack of
understanding that a figure below a certain standard (at one time, 4.0)
could indicate PSA.  And, a final part was that PSA is very slow growing and
develops over years and this growth can be tracked from the very beginning
with ultrasensitive testing.

Because of this metamorphisis of knowledge, my father was diagnosed two
years after his symptoms were reported to his GP and only when they could
find a spot on his pelvis with an x-ray.  Because of the discovery of PSA, I
was diagnosed long before I had mets.  But, because of older testing
sensitivity, and the old standard of 4.0,  and that I wasn't 50 yet, and I
skipped a year, when diagnosed, I was already a Stage T3c with a 16 PSA;
i.e., almost certainly terminal (which, in 2003, was confirmed).

Due to the power of anecdotal evidence, I can prove that it makes a
difference in diagnosis.  Of the 800+ who have joined this club and NG since
I, about 10% were diagnosed with a PSA of less than 4.0.  Of these 84, only
four were diagnosed before 2002!  And two of those had very high Gleasons
which may indicate they were no asymptomatic (perhaps a stretch).  Six were
0.50 or less.  One, was 0.060.

I therefore submit for discussion that ultra-sensitive testing for initial
diagnosis of prostate cancer is indicated.  If Strum said "two years head
start" regarding initial diagnosis, I believe he was being
ultra-conservative.

PSA TESTING OF THOSE WHO HAVE HAD SURGERY

The hope and desire of men and medics after surgery is to have zero PSA,
testosterone coarsing through our veins, a penis harder than Chinese
arithmatic, and a Kegal muscle with a clamping limit of 1700 psi.  Well, we
can't have it, at least not the PSA.  For all the reasons we all know, there
is going to be PSA and it will generally be produced at levels below 0.1.
However, if we stay at those levels for 50 years, we are considered cured.

If we don't make it to less than 0.1 but we level out at just above it, we
consider other factors that might produce more PSA.  If it sneaks up to 0.27
a year later, then 0.37 three months after that, you're off to the radiation
factory.  During that first year, it is possible that it was undulating in
the hundredths or even thousandths of a PSA, but knowing that was of no use
to the patient or the doctor.  The key to setting off salvation treatment
would have been 0.1, then 0.27, then 0.37.  I could be wrong, but I don't
think Strum would send a patient to SRT for scores fo 0.004, 0.027, and
0.037 (which would be <0.040 and undetectable by one assay).

Ergo, I submit for discussion that testing at tenths of a PSA is sufficient
for men who have undergone surgery.

PSA TESTING AFTER RADIATION

I'm a little less familiar with the vagaries of radiation testing and
results, but if I understand things correctly, the most important result is
a nadir.  I also understand that most successful treatments result in a
nadir of about 0.15.  Very few are over 0.2 and very few are below 0.1.
While have a 0.05 might be great for bragging rights, there is probably
little need of knowing it is that low.  Most oncologists will not act on RT
failures until it has cross over 0.2 once, then rise again after that.

Ergo, I submit for discussion that testing at two-tenths is sufficient for
men who have undergon surgery.

PSA TESTING AFTER ADT

I'm still working on this one.  It seems like PSA testing alone might be
insufficient.  Although, I'm currently using an assay that tests to 0.040
and that seems to be about right for me and my situation.