^ All very interesting. I am increasingly of the view that PSA alone can indeed be a poor, sometimes contradictory, guide to disease progression, particularly for recurrence.
With a level of 2.9, 4 years after RT, psa nadir <0.03, from 0.29 1 year previously, and then a follow up 3 mths later of 4.5, my consultant initially outlined 4 (?) potential treatments. Once seen PSMA PET scan, distant metastasis, numerous lymphs (not bones), dropped to only one, HT.
The point is that 2.9 to 4.5 not normally a reflection of distant spread. Further, 4.5 is in this instance NOT a good sign. Rather it is an indication of a likely speedy progression to castrate resistant. Similarly, while on the face of it the magnitude of the drop iin my psa from 4.5 to 0.95 after only 28 days is encouraging, it is NOT. Such a large %age drop is also an indicator of a very rapid move to castrate resistance.
PSA monitoring is cheap and easy, but in some cases tells one nothing. Although rare, there are well documented cases of constantly negligible psa with massive fatal spread.
Whether or not this will push me to private scans (PSMA PET at c. 3-4 grand?) I do not yet know!
Good luck all, Dave.