Can RP be performed for patients with very High PSA Levels?
Dear All, I read this article with considerable interest. The reason being is that I vociferously objected once at a conference when a paper was presented where RP was performed with very high PSA. We were all under the impression that PSA over 20ng/mL represented higher incidence of metastatic P Ca and not picking up Mets by Bone scan of yesteryears did not rule out no bone mets. After reading this article, wherein though the authors have confessed to the limitations of the study, I have to openly apologize to those whom I openly hurled my comments which includes a close associate of mine as well. https://jnccn.org/view/journals/jnccn/17/8/article-p941.xml?utm_source=Email&utm_medium=Email&utm_campaign=JNCCN%20ETOC%20In%20Focus%209.4.19%20Ongoing&email=0547bdc5929119da8f7018d8b3235272ebad352f176fcf6585a304d025ad2bc6 (PDF available) Recently with the advent of 68Ga-PSMA PET scan more exact staging can be achieved and especially in patients with high PSA levels need exact Staging. As informed to me by an expert in Nuclear Medicine, PSMA scan can be considered as a ‘one stop test for P Ca’. Recently functional Imaging such as these are also able to provide information as regards the disease within the prostate and also able to give information regarding its aggressiveness. What piques me is the fact that if RP can be offered in most instances, High PSA levels as indicated, in Oligometastatic Disease and as salvage therapy after other modalities of treatment, the why do we have to study the disease so extensively prior to offering treatments. If all these advanced disease have favourable outcomes with RP, why not perform RP for all P Ca’s irrespective of advanced nature of the disease. With warm regards VenuView Document