PSA Now Detectable After Surgery??

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Davisal
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 12/22/2008 8:36 AM (GMT -7)   
I just received a call from my surgeon's office with the results of my most recent PSA test.  The PSA is now detectable, but at a very low level of .01.
 
My Davinci prostate removal surgery was on Aug 8th and my first PSA afterwards was a level of .00.
 
Does a now detectable level of .01 mean that some of the prostate tissue remains and indicates possible trouble for me??
 
Thanks, Dave
 
 

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 12/22/2008 8:47 AM (GMT -7)   
.01 is considered undetectable by most standards, but do you have any more information regarding your pathology report? Is there a chance the lab is different? Wishing you the best?
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Davisal
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 12/22/2008 9:26 AM (GMT -7)   
It is disappointing and a bit frightening to have a perfect .00 test, then now get a detectable level of any amount.
 
The blood work/test was done at the same lab there in the surgery center as the first test so I would assume the blood work/tests would/should be consistent.
 
I don't have any other info and am not sure exactly what other info you are referring to.
 
Thanks, Dave
 
 

hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 12/22/2008 10:05 AM (GMT -7)   

Dave,

.01 is considered undetectable. Are you sure the first test was 0.00? Perhaps it was something else (like 0.01) and you were told 0.00 - meaning undetectable. Did you see the report?

It would be interesting to know. But in any case - I wouldn't worry since the testing equipment is not that sensitive and .01 is considered 0.

Good luck to you - enjoy the good news.

 


Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08 < 0.05


jackcc
Regular Member


Date Joined May 2006
Total Posts : 80
   Posted 12/22/2008 10:25 AM (GMT -7)   
.01 is considered undetectable not detectable. Don't get worried. Many guys would love to have a PSA reading of .01. I can't imagine why your doctor would call that "detectable". Anytime you have a .0 something, you're okay. Maybe its simply the number 1 that showed up after a reading of .00. Your PSA reading of .01 is excellent. Your doctor needs to explain more to you.

Post Edited (jackcc) : 12/22/2008 9:31:39 AM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7756
   Posted 12/22/2008 11:47 AM (GMT -7)   
Hi Dave,
Did our suegeon state it was undetectable or detectable? Using those words? Undetectable is anything below 0.1 in most books. And if you have the misunderstood him is it possible he meant 0.1 not .01? Sounds like you need to call him back. If he is saying you now have a detectable PSA, you should have him retest it to verify it's validity.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


Davisal
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 12/22/2008 4:40 PM (GMT -7)   

It was one of the nurses at the surgery center that called me both times to report the PSA test result.  First test after surgery was .00.  The most recent test last week was reported as .01.

The surgeon himself, during one of my post-surgery follow up appointments, described the PSA test result that we were looking for and expecting was .00.

To me .00 means that absolutely no PSA was detected in the first test and in the second and most recent test, a small amount of PSA was "detected".  Even though it is a minute amount (.01), in my mind I went from perfect to maybe not so perfect.  I am now a bit apprehensive about the situation as this could be a first indication of a not so perfect and complete removal of the cancerous prostate. 

Thanks for the moral support.  Hopefully it will turn out well for everyone on this forum.

Dave


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 234
   Posted 12/22/2008 8:01 PM (GMT -7)   
I agree with others that the test isn't that accurate, particularly at the bottom end. I would try not to get too worked up over it. Hoping you stay on track in 2009.
50 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
6 Wk PSA - 0 
So far, so good.  Next PSA in another 6 Wks
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 1514
   Posted 12/22/2008 10:25 PM (GMT -7)   
The difference between a 0.00 and a 0.01 test result is meaningless, zippo, nada, nothing.  Your PSA is undetectable by any standard!  Take it easy and enjoy the holidays. 

PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 06 at age 57
Organ confined to one small area Gleason 5   
PSA's undetectable  < 0.1  


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 12/22/2008 10:37 PM (GMT -7)   
PSA can be caused by residual "healthy" prostate tissue left behind.  As mentioned above, ANYTHING below .1 is still considered undectable.   Or put another way, you probably wouldn't seek out further treatment until you say a PSA north of .1, especially if you have a clean pathology.
 
Don't let the little moves drive you nuts... if your PSA REALLY starts to move down the road, you'll know it --- hope that doesn't happen.  CHill out, enjoy the holidays, do your follow up PSAs as your doctor suggests...and consider yoourself cured until proven otherwise!
Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable


mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 12/23/2008 6:19 AM (GMT -7)   

I agree with TC-LasVegas because 0.01 is considered nondetectable.

When I left the Dr after my first psa test post sugery I thought he said mine was .028 which is considered non detectable , but he told me I need radiation, I called back and found out my number was 0.28 not .028 , big difference, so call your Dr back


50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
psa aug 2007 0.28
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14
psa aug 21, 0.16
psa dec 17 o8 , 0.16


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24401
   Posted 12/23/2008 6:57 AM (GMT -7)   
I agree with the others here, .01 is technically undetectable, if it climbs to .02 then .04, then there would be a serious concern. Some of it depends on the tolerance and limits of the testing equipment that explains some of the different post surgery psa readings you see here. Like someone else said, if it came back .1 that is a whole different animal. So if it is really .01, then I would accept that as a legitimate zero and give thanks and enjoy. Have a good holiday.

David in SC
Age 56, 56 at DX
 
PSA 2007 5.8
PSA 9-2008 14.9
 
3rd Biopsy 9-2008 Positive
7 of 7 cores positive, ranging from 40 - 90%
2 tumours noted, Gleason 4+3 and 3+4
 
Open RP surgery completed on Friday, November 14, 2008 at
St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon,
Non-nerve sparing, 4 days in hospital, staples removed 11/24/8,
Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08 - uncertain of what went wrong.
 
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes. Left lobe: infiltrating tumor miscroscopically appears to extend to marked left posterior margin
 
First PSA Post Surgery  Scheduled for 1/5/9
 
 


Frd63
New Member


Date Joined Oct 2008
Total Posts : 2
   Posted 12/23/2008 12:24 PM (GMT -7)   
I am exactly in the same situation. I've had my RP in April 2007 and all my tests were <0.01 until September. My September results show =0.01. I saw my doctor right after my test and he actually didn't mention this to me. I always get a copy of my test results and that's how I found out about it.

I know that until it rises to 0.1 no course of action is recommended, but the fact that it is now detectable by the test equipment causes us to be apprehensive about it.

Fred
Age 45 (44 at the time of Dx),
Pre op PSA 4.48, 3/8 positive biopsy.
RRP at Royal Vic, April 30, ‘07.
Pathology: 3+4, pT2C, Tumor invades the prostatic apex, neg for extra prostatic extension, neg margins.
Post op PSA: 2, 7, 14 months PSA <0.01. Last PSA=0.01 (Sept 8, ‘08) .


apacker1950
Regular Member


Date Joined Nov 2008
Total Posts : 109
   Posted 12/23/2008 5:52 PM (GMT -7)   
Different labs have different levels of sensitivity in their testing. For some .1 is considered undectable, others may be .01 or .02. My level has been .01 for 3 years now and is considered undectable. Try to relax and have a great Holiday Season. Merry Christmas to one and all.
Age 54 at Dx.   Currently 58
Jly 05- PSA 8.1
Sept 05- PSA 10.7
Sept 05- Biopsy revealed 9 of 12 cancerous, Gleason 3+3=6, T2 stage
Bone scan and cat scan showed hot spot on hip bone.
Oct 05- Surgery for bone biopsy.  Pathology showed benign growth, no cancer in bones. Who ever thought I would be happy to only have PCa?
Nov 05- PSA 15.4
Nov 18, 05- Nerve sparing open RP at Huntsman Cancer Center, SLC, UT by Dr. Robert Stevenson. 
Home after 3 days.Cath out at 2 wks.
Incontinence gradually improved for about 3 months to 100% continence.
ED- Tried the big 3 pills with no results
Feb 06- PSA undetectable, Started VED which worked but caused discomfort with constriction rings.
May 06- PSA undetectable, Dr. gave me an Rx for Trimx injections. They work great.  Still use VED on off days without constriction for therapy.
Aug 06- PSA undetectable 
Nov 06, May 07, Nov 07, May 08, Nov 08 - PSA undetectable
ED appears to be perminant but doing great with Trimix.


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 630
   Posted 12/23/2008 8:17 PM (GMT -7)   
Absolutely....I agree with everyone! I think anything under 1.00 is very good.....Pete went from 0.52 to 0.6 and we were happy. That could very well be within the limits of the sensitivity of the test.... Forget about it.....Get pomegranite juice and blueberries and enjoy your life.....It is Christmas. Forget about the darned cancer!! xxxDiane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
Waiting to see if AUS gets better results
Complete hip replacement surgery coming up Jan 9, 2009


ScubaDave
New Member


Date Joined Jan 2009
Total Posts : 7
   Posted 1/22/2009 8:18 PM (GMT -7)   
Davisal,

Did you try the Osbon ErecAid Penis Pump Kit you mentioned earlier? Any results?

51 years old and in good shape
I was diagnosed with a PSA of 2.0 last winter
Last summer it went to 4.9
12 biopsies revealed a Gleason score of 3 + 3 in 2 out of 12 slices
Robotic Da vinci surgery on Dec. 10th of 2008
Catheter for 9 days, in hospital for 20 hours - no pain and was walking within 16 hours
Using one pad a day, none needed if I watch my fluid consumption
Not much luck down below but seeing small improvements weekly but not enough for intercourse, tried cialis and now the blue pill.
Went back to work today after 6 weeks, did okay but notice a little more leaking - I'm a PE teacher so have to be on my feet. I'll bring an extra pad tomorrow.

Does the pump work and did your insurance help with the 400 dollar bill?

I appreciate this web site and look forward to "meeting / chatting" with others in this crazy chapter of life.

Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 197
   Posted 1/23/2009 1:31 PM (GMT -7)   

The lab that reports on my blood work does not report below .1  It is my understanding that anything more precise is subject to various irrelevant things that could create a bounce one way or another.

I suggest that you get a copy of the actual lab report. I bet there's a "<" before your number, which indicates it is less than whatever the actual number is. 

To me, the difference between .1 and <.1 is big and would be good to know.

If your number is truely .01 (not .1), you should be thrilled.  There seems to be some confusion whether the threshold is .01 or .1. It's my understanding it's .1



Age:54
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.

Post Edited (Dave7) : 1/23/2009 12:35:30 PM (GMT-7)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/23/2009 4:21 PM (GMT -7)   
I won't repeat much.

The standard test begins at .1. I have asked several Drs. if there is such a thing as a .0 on the standard test and none of them have been able to answer. The ultra sensitive test goes a tenth lower.

I would first ask which screen is being run. I cannot find much support for the ultrasensitive screen.

Hoping, and thinking, you are fine.

Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 1/23/2009 5:28 PM (GMT -7)   
Davisal. You might find this article from the 'yana' site a helpful read. The variation you are looking between the two readings is infinitesimal and not worth thinking about.

www.yananow.net/UltraPSA.htm

Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

Post Edited (BillyMac) : 1/23/2009 11:55:53 PM (GMT-7)


Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 1/23/2009 6:03 PM (GMT -7)   
I am one (1) year out, and after three <0.01 PSA's (all from the same lab) I recently got a 0.01. Of course I was bummed, and at my scheduled one year visit we discussed the issue at length. First, my doctor said that most likely, the lab simply left off the < symbol, and that he "sees it ALL the time". He did not want to immediately repeat the test, and said we would re-test at the regular 6 month interval next visit. I was insistent, and he compromised with a three month re-test. Bear in mind that I had a perfect post-surgical pathology report (as far as margins, containment, lymph/seminal vesicle/bladder resection margins) and a relatively low (5.0) pre-surgical PSA. The other two urologists I consult with for incontinence (now much better) and ED issues, both said "don't lose a second of sleep over it", and other such remarks. Easy for them to say.

So my money says that we're in the same boat, and that we'll both have <0.01's next time around.

Now I see first hand the ultra-sensitive PSA anxiety I've read about all these years....
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01


Davisal
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 1/23/2009 7:59 PM (GMT -7)   
I have not seen any of my lab reports and only know what was told to me by the Surgeon's nurse that called to report each PSA test result.
 
As mentioned earlier, the surgeon said our goal was a .00 which would indicate absolutely no prostate tissue remains so needless to say when my test result went from a perfect .00 to .01, I was and am concerned.  In plain words the surgeon said if no prostate tissue remains and/or exists, the test result should be .00.  I am anxiously awaiting my next test.
 
Dave

Davisal
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 1/23/2009 8:05 PM (GMT -7)   
I don't know what the little symbols = < (before the PSA number) mean.  Can someone explain?
 
Also, some here mentioned post-surgical pathology report, margins, containment, lymph/seminal vesicle/bladder resection margins, etc.  What is all of that about?  I have had no post surgical tests other than the PSA tests.
 
Thanks, Dave 

Davisal
New Member


Date Joined Dec 2008
Total Posts : 15
   Posted 1/23/2009 8:31 PM (GMT -7)   
Yes, I did purchase the manual Osbon ErecAid Penis Pump Kit.  My insurance (BCBS) would not cover any of the cost.  The company offered it to me at a negotiated discount price of $350.
 
The pump does work, but it is uncomfortable, and takes time and repeated pump up/release cycles to reach what I remember as my normal erect length.  The erection will immediately go away as soon as the pump is released.
 
Using one of the medium size silicone rubber rings to hold an erection was very uncomfortable and would not hold an erection suitable for intercourse.  Using a smaller size ring was downright painful.  Tried it once and never again.
 
The blue pill doesn't seem to help any and BCBS insurance will not cover it either.  My pharmacy cost for 10 of the 100mg Viagra tabs is $110.  Does anyone else have BCBS and get them covered?
 
I have seen no natural erection or improvement since the surgery.  With wife's manual stimulation, orgasm can be reached, but causes much soreness and pain in the prostate area for 2-3 days afterwards.
 
Post surgery prostate area pain and tenderness has subsided alot, but still exists.  Incontinence has improved, but still leaking a little here and there now at 5 months.
 
Dave
 
 
 


Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 1/23/2009 8:31 PM (GMT -7)   
Dave:

The < symbol denotes "less than".

In this instance, I have been told that the "ultra sensitive test" (aka: diagnostic/DX) is "accurate" down to in effect 0.009, not including the inherent "slop" in the test itself, and of those conducting the test/running the equipment and/or it's calibration accuracy (lots of slop there). Someone else posted a link to a site discussing the ultra-sensitive tests, and also simply Google "ultra-sensitive PSA test" and you'll get a plethora a stuff, some of which are from medical journals and hence jargon-intensive/headache inducing wink

While I am supposed to wait until late March to re-test I am considering simply going to my regular doctor and having him write out a lab request for the PSA test and simply pay out of pocket for it (around $100 as I recall) just to shut off the noise in my head. The mind is incredibly powerful, as I have periodically been having random pains similar to the ones I had waiting for surgery thinking it was all over my body.

Ironically, with a clean pathology not many if any doctors will do radiation/hormone treatment until it reaches 0.1 anyway, so in that event as many books have said, the ultra-sensitive tests can cause more trouble than they are worth. They may be onto something.

God I am sick of this crap.
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01


Tobmeister
Regular Member


Date Joined Jan 2009
Total Posts : 41
   Posted 1/23/2009 9:24 PM (GMT -7)   
Jetlagged, my urologist charge for PSA is only $12.
Tom, age 51
Diagnosed 11/12/2008
PSA 2006 - 2.8, 2007 3.06, 2008 4.6 (remember the rate of increase is as important as the level), PSA free 8.7%
Gleason score 7 (4+3); 6 out of 19 cores sampled positive for cancer; perineural invasion present
Bone scan and CT scan both negative
Prostate mildly enlarged, DRE negative
DaVinci radical prostatectomy 12/30/2008 - Duke Medical Center - left side nerves spared
Scheduled for catheter removal 1/15/2009

"Pick a good doctor and say your prayers"

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