Hi. I don't have this direct experience, but have done some reading, and can provide references, that may help ease your mind.
Some surgeons specifically tell their patients to get only the “standard” PSA test after surgery specifically to avoid what is called “PSA Anxiety.”
As you have already pointed out, Dr Catalona is (in your words) “dismissive of anything below .1.” Why is this? One reason is that unilateral or bilateral nerve-sparing surgery will leave benign tissue behind which produces PSA at a level detectable by the “ultra-sensitive” PSA tests.
Additionally, there is also normal day-to-day variation of PSA results which are evident only with the detection levels of the “ultra-sensitive” PSA test. This article “The Downside of Ultra-Sensitive Tests” reports normal variation within the range of what you are seeing:
The concluding sentence in the article reads:
''It's important that we don't assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it's less than 0. 1, we assume it's the same as nondetectable, or zero.''
Hope that this helps ease your mind...
This is a VERY interesting thread.
I know Dr. Strum really pushes for the ultrasensitive test. Part of me agrees in th sense that more information is better than less information.
But in this case, maybe not. My doctors are against the ultrasensitive test precisely for the reasons shown in this thread. It causes way too much aggravation/stress.
But it is not a clearcut choice, for sure!
Mel (10 days away from my first post-op PSA test)
63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%), after 45 days on cipro! DREs have always been normal. PCA-3
Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.
Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear. Perineural Invasion: yes. Seminal Vessical Involvement: No. Extraprostatic Extension: yes. Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.
Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was using 1 pad at night for security, but pretty much dispensed with that most nights.
Next Event: First post-op PSA on 3/1/10