In last month’s post, I asked readers to complete a short survey to get a better idea of the PSA threshold that would dictate the beginning of salvage therapy. The survey asked:
- How their medical teams defined “undetectable” PSA levels.
- How their medical teams defined biochemical recurrence after a prostatectomy (what PSA level).
- At what PSA level did they and their medical teams decide to begin salvage therapy.
- How long after PSA biochemical recurrence was it before salvage therapy began.
Before going into the results, I first want to thank those who took the time to participate. You may view the results using the link below:
I could have designed the survey better. I probably should have asked for post-surgery Gleason score and pathology to see if there was a correlation between a higher Gleason score and acting earlier at a lower PSA level. The sample size is small enough where it’s not statistically significant, but there were some interesting observations:
- The definition of “undetectable” generally ranged from <0.01 to <0.1 ng/ml. I believe that to be a reflection of whether the traditional PSA test or the ultra-sensitive PSA test is being used.
- The consensus for the definition of biochemical recurrence seemed to be 0.2 ng/ml.
- The PSA level at which some sort of salvage therapy began was widely spread between 0.17 ng/ml and 3.5 ng/ml.
- The time to begin salvage therapy after biochemical recurrence varied from one to 35 months.
[Note: I’ll keep the survey open for a while longer and new responses may skew the summary above.]
For me, there aren’t any real “A-ha!” findings that provide clarity, and I expected that going into this exercise. The only thing that’s clear is that each case is unique—from both the patient’s perspective and the medical team’s perspective—and that means that my numbers will be different from your numbers and those will be different from Sam’s numbers and all of us will act (or not) on those numbers differently.
It is nice to know, however, that my medical team is in alignment with others on some of the measures.
And just to prove that I’m not nuts obsessing over the definition of biochemical recurrence, a somewhat dated research paper (2007) showed “a total of 145 articles contained 53 different definitions of biochemical recurrence for those treated with radical prostatectomy….In addition, a total of 208 articles reported 99 different definitions of biochemical failure among those treated with radiation therapy.” [Emphasis added.]
No wonder there’s confusion among us patients!
For me, the key statement in that paper was, “The Panel acknowledges that the clinical decision to initiate treatment will be dependent on multiple factors including patient and physician interaction rather than a specific prostate specific antigen threshold value.”
It’s up to us.