Low PSA not the end-all .. Re: Recurrence after surgery, questions

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Low PSA in this case was a total distraction. Should have been watching other markers as well. Sam.1. Korean J Urol. 2010 May;51(5):358-61. Epub 2010 May 19.Progression of prostate cancer despite an extremely low serum level ofprostate-specific antigen.Lee DK, Park JH, Kim JH, Lee SJ, Jo MK, Gil MC, Song KH, Park JW.Department of Urology, Korea Cancer Center Hospital, Seoul, Korea.A 61-year-old man who had been diagnosed with prostate cancer 9 years ago and hadbeen treated with pelvic irradiation and intermittent androgen deprivationtherapy visited the emergency room because of back pain and weakness in bothlegs. Spine magnetic resonance imaging showed a lumbar epidural mass and spinemetastasis. The whole-body workup revealed multiple metastases to the lymphnodes, bone, liver, and lung. The serum prostate-specific antigen was 0.02 ng/ml.He underwent laminectomy, posterior fixation, and epidural mass excision, andmetastatic adenocarcinoma from the prostate was diagnosed. The patient underwent 1 cycle of docetaxel-based chemotherapy. More chemotherapy could not be donebecause of his general weakness. The patient died one month later of multipleorgan failure.PMCID: PMC2873892PMID: 20495701 [PubMed - in process]> >> > Had surgery in Feb. 06. Biopsy and pathology reports were very positive, no penetration, clear margins, no invasions, etc. Urologist had very positive outlook. PSA undetectable at less than 0.05 until recent annual checkup. Got a PSA reading of 0.07. Doctor (GP) not overly concerned and said we need to watch this. Watch my a... I about fell off my chair. So a couple questions to start with:> > > > 1. How accurate would the testing be at this level?> > 2. Is it usually possible to get a "walk in" PSA test at another hospital? I'm thinking a big city cancer center.> > 3. Is there a more accurate PSA test for this? I'm thinking of the PSA2 test I had for the initial condition back then. > > 4. At what point would treatment be necessary? Seems like sooner rather than later?> > 5. I've heard of "salvage radiation", is this the usual procedure for a recurrence after surgery?> > 6. Anyone had this? General description of the treatments and side effects? Or a blog or write up would be appreciated. > > > > Just getting started on this deal.> >>