Without radiographic evidence for metastatic disease, is there a PSA value above which high risk localized prostate cancer should not be treated definitively?

In other words, is there a PSA value above which metastases are imminent?

Answer from: Radiation Oncologist at Academic Institution

The SPCG-7/SFUO-3 randomized trial randomized 875 patients to endocrine only therapy vs. endocrine therapy plus radiation therapy. 20% of the patients had a PSA > 30. The addition of radiation showed an overall survival benefit at 10 years (60.6% vs 70.4%), a prostate cancer specific survival ben...

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Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System
"The higher the PSA - the more important the radia...

Answer from: Radiation Oncologist at Community Practice

https://www.ncbi.nlm.nih.gov/pubmed/22483701This is largest study with treatment outcomes in non-metastatic prostate cancer patients With Ultra-High Prostate-Specific Antigen showing the benefit of local treatment.

Answer from: Radiation Oncologist at Academic Institution

The higher the Gleason score and the higher the PSA (>20 ng/mL), the more likely that a bone scan will be positive. However, other techniques such NaF PET may have a higher detection of bone metastases. Personally once the PSA is > 50 I start questioning the value of definitive therapy, but I ...

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Without radiographic evidence for metastatic disease, is there a PSA value above which high risk localized prostate cancer should not be treated definitively?

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