PSA Testing (Ultra sensitive)

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Rusty Seaview
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Date Joined Oct 2010
Total Posts : 10
   Posted 3/12/2013 6:45 PM (GMT -6)   
I'm aware there are reasons to not test your psa post operatively using the Ultra sensitive method. I want to share my experience having done it. 5 years ago this April I had robotic surgery to remove my prostate. My psa was 4.1 and the biopsy indicated Gleason 6. Post surgery it was upgraded to Gleason 7 3/4. It had extra capular extension but there were no positive margins. For the first 4 years that I tested my psa using the ultra sensitive method my psa ranged from .023 to .037. Then at the 4 year point my psa tested at .05 and I did it two more times once using a different lab and they both came back .04. I went to my urologist and he recommended I see a radiologist and get prepared for doing radiation when it rose over .1 or .2. My wife and I visited the radiologist and of course the whole experience of talking about the treatments was somewhat upsetting. 3 months later I get my PSA tested again to see if it had risen much from .04/.05 to sort of judge how long I had before radiation and I was surprised to see my PSA was back down to .023, waited another 3 months and it was .023 again. The doctors have no explanation of why this happened but if I hadn't been doing the ultra sensitive test that little experience would have been avoided because I would not have known since it doesn't look at anything under .1 When my psa had gone to the .04 and .05 area I tested it several times as I indicated with different labs so it was actually up for that brief period of time. I was wondering if anyone had any comments about this.

142
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Date Joined Jan 2010
Total Posts : 5912
   Posted 3/12/2013 6:52 PM (GMT -6)   
And that is why my uro will not do an ultrasensitive PSA.
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12;Prolia 6-mo inj 12/12

BillyMac
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Date Joined Feb 2008
Total Posts : 1821
   Posted 3/12/2013 7:14 PM (GMT -6)   
Well there are two lines of thought with this and I suppose it depends on your personality. I think you will find that the analytical/engineering type fellas will opt for ultrasensitive over standard. When I had my op I wanted to know if the operation had been successful or not. PSA tests to the standard level i.e <0.1 are not really indicative as to whether a cure has been effected ------ ultrasensitive to the third decimal point is a great pointer if it is in the less than 0.01 region (as is a consistent and relatively unchanging very low PSA. Should a relapse occur from such a low base you can have as much as 2 years prior notice that additional salvage treatment may be in store.
Some people may not want to know till relapse becomes apparent by the PSA exceeding 0.1 and climbing. Of course all this can be further complicated by residual benign tissue left as a result of nerve sparing. It just depends on how one approaches problems.
Bill

Post Edited (BillyMac) : 3/12/2013 8:09:13 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24280
   Posted 3/12/2013 7:23 PM (GMT -6)   
just glad that you are able to bite the "radiation bullet" for now, hope it stays that way for you.
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

BOOGEE
Veteran Member


Date Joined Jan 2012
Total Posts : 557
   Posted 3/12/2013 8:08 PM (GMT -6)   
Rusty,
 
We had the reverse . After having been on HT for 1 year and having TRADITIONAL PSA's, our local prostate group encouraged us to have an ULTRASENSITIVE PSA.
We did so and my husbands reading was <0.1 with TRADITIONAL and 0.1 with ULTRASENSITIVE We also changed Dr's.as our Urologist  didn't think it was necessary to do ultra PSA'. We then found a new Oncologists and he agreed doing an ultra test is unnecessary. We then went back and had another traditional PSA and it came back <0.1
 
Dr agreed let us have a HT holiday for now. My husband's PSA will be rechecked in April, and quarterley until or unless it starts to rise.
To sum up our Oncol.said Ultra tests are too much info! We are back to traditional ones.
 
BOOGEE
 
Age 53
2010 PSA's 6.3, 4.7 5.6
RP open Oct -2011
Stage T1c
Gleason 4+3 left side Gleason 3+3 right side
11 lymp/ no mets.
Perineural invasion present
neg. marg.
Path staging (pt1): pT2c: bilateral disease
PSA Post -Op
1.2 11/2011
1.8 12/2011
3.5 1/2012
2-12Casodex Lupron PSA .03,
5/12 PSA <0.1, T-12
CT, BONE, MRI Neg. for Mets.
F-18/FDG showed 1 met.,spine T-11

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 977
   Posted 3/12/2013 8:37 PM (GMT -6)   
I don't think that there is a right or wrong answer. It all comes down to your personal situation and preference.
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11
PSA 10/11 < .01, T 103
PSA 1/12 < .01, T 214
PSA 6/12 < .01, T 380
PSA 1/13 < .01, T 389

Rusty Seaview
New Member


Date Joined Oct 2010
Total Posts : 10
   Posted 3/12/2013 8:54 PM (GMT -6)   
I think you could be right BB Fan.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2621
   Posted 3/12/2013 9:12 PM (GMT -6)   
Rusty,

As a Gleason 9, I have insisted on ultrasensitive, aside from the doctors. When they order a PSA , I have the nurse write ultrasensitive.

It is my belief that trends are more important than the actual number. A given result in a test or in 2 tests is not as important as to me as the trending. I decided on SRT after 6 consecutive rises over 18 months, even tho it only rose to .06.

So I agree that some have a hard time dealing with ultrasensitive and a <.1 is ok for them to believe it is underectable, but any thing greater than the lower limit is detectable, no matter how small, no matter what the source.
Goodlife


Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9 Da Vinci, Cleve.Cl 4/14/09 pT3a NO MX,
Neg Margins, PSA 6 wk,<.03, 3 mo. <.01 (dif lab),
mo. <.03 , 6 mo. <.01, No pads, 1/1/10, 9 mo. < .01, 1 year .01, 15 mo. <.01, 18 mo. .01, 21 mo. .02, 24 mo. .03, 27 mo. .02 , 30 mo .02, 33 mo .04, 36 mo. .06. 37 mo. .06
SRT begun 6/12. PSA .04 9/12 .03 10/12 .04 2/13

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2685
   Posted 3/12/2013 10:07 PM (GMT -6)   
An ultra sensitive test post op will not tell you that the cancer is cured any more or less than std. At this point in time, nothing will. Rusty your point is the crux of the ultra/ std conundrum.
Diagnosed 8/14/09 psa 8.1 66,now 69
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough ED penatration at 2 years with cialis/viaga. < .1 at 33 mod < 0.1 @ 39mos

Post Edited (logoslidat) : 3/12/2013 9:11:28 PM (GMT-6)


goodlife
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Date Joined May 2009
Total Posts : 2621
   Posted 3/12/2013 10:24 PM (GMT -6)   
Logo,

Just so I understand, you are saying that a .09 post surgery at 3 months would be no more informative to you than a <.1, or indicative of a successful surgery, as opposed to a <.01 ?

I'm not saying either is necessarily indicative of a cure, but for my curious mind, I would much rather see the <.01 or .09 than <.1.

Maybe it's just the way I am built. I pick up pennies from the ground too.

Goodlife

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 3/12/2013 10:49 PM (GMT -6)   
logoslidat said...
An ultra sensitive test post op will not tell you that the cancer is cured any more or less than std. At this point in time, nothing will. Rusty your point is the crux of the ultra/ std conundrum.


I disagree logoisdat. PSA below 0.1 could be anything from 0 to 0.099. The aim of a prostatectomy is to remove the prostate and all tumour which will result in essentially zero PSA. Residual microscopic tumour (either local or metastatic) will not produce detectable PSA, even at the ultrasensitive level. However as the cells divide and double in number the PSA will inexorably creep upwards reflecting the number of tumour cells present. This is why the doubling time of PSA is so important ------ it is a great indicator of how fast the tumour cells are dividing i.e. the cancer is growing. Tumour cells left following surgery and tested for via the standard PSA test may well be growing for two years (and sometimes slower) before the presence of residual tumour is detected via a PSA reading exceeding 0.1. Testing at the ultrasensitive level will reveal this growth at a far earlier stage

From the article below:
Chi-square analysis demonstrated that men with a PSA nadir of less than 0.01 ng/ml had a significantly lower rate of biochemical relapse than men with a nadir of 0.01 ng/ml (p 0.01), 0.02 ng/ml (p 0.025) and 0.04 ng/ml (p 0.01). There was no significant difference in relapse prevalence between the PSA nadir 0.01 and 0.02 ng/ml groups but the relapse prevalence in these 2 groups was significantly smaller compared to that in the 0.04 ng/ml or greater nadir group (each p 0.01).

webdoc.nyumc.org/nyumc/files/urology/attachments/shen_lepor_taneja.pdf

But as I said the whole issue can be clouded by residual benign tissue in which case you want the PSA to remain static over the long haul.

I guess one's preference boils down to:
Personality A ------- I want to know what's happening
or
Personality B ------- I don't want to know till it happens

In Rusty's case it would appear at first glance that residual benign prostate tissue (usually as a result of nerve sparing surgery) was left at the time of his op, giving him a PSA reading (at very low but relatively static levels)
Bill

Post Edited (BillyMac) : 3/12/2013 10:00:58 PM (GMT-6)


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2685
   Posted 3/12/2013 11:10 PM (GMT -6)   
goodlife, billy mac. Relax my post should be read very straight fowardly. do you agree with what was posted or do you disagree with what you think I said? Or both? or none of the above. The words are there and or not hiding behind anything in my mind or yours. Are we Kew on that?
Diagnosed 8/14/09 psa 8.1 66,now 69
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough ED penatration at 2 years with cialis/viaga. < .1 at 33 mod < 0.1 @ 39mos

Post Edited (logoslidat) : 3/12/2013 11:04:35 PM (GMT-6)


Traveller58
Regular Member


Date Joined Mar 2013
Total Posts : 49
   Posted 3/16/2013 10:41 AM (GMT -6)   
Hi BillyMac,
I am the analytical type person and I feel more comfortable if I know what's happening. I am also having ultrasensitive PSA tests and recent ones are at 0.003 ng/ml. My question is does it ever go below that level? Can it be 0.000?
thanks and take care
Traveller58

BillyMac said...
Well there are two lines of thought with this and I suppose it depends on your personality. I think you will find that the analytical/engineering type fellas will opt for ultrasensitive over standard. When I had my op I wanted to know if the operation had been successful or not. PSA tests to the standard level i.e <0.1 are not really indicative as to whether a cure has been effected ------ ultrasensitive to the third decimal point is a great pointer if it is in the less than 0.01 region (as is a consistent and relatively unchanging very low PSA. Should a relapse occur from such a low base you can have as much as 2 years prior notice that additional salvage treatment may be in store.
Some people may not want to know till relapse becomes apparent by the PSA exceeding 0.1 and climbing. Of course all this can be further complicated by residual benign tissue left as a result of nerve sparing. It just depends on how one approaches problems.
Bill

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 3/16/2013 5:24 PM (GMT -6)   
Traveller,
The Siemens Immulite 2000 when used to test for PSA at the ultrasensitive level can detect PSA down to a level of 0.003 ng/mL. If the actual PSA content of the blood specimen is below this, it will register as "not detected". The blood PSA level may actually be 0.002 but at such a low level the assay does not "see" anything as being present. But measurements at such very low levels can fluctuate by 20% even when testing samples from the same blood vial. For this reason a report is often limited to 2 decimal places even when the mathematical result was three (although some labs do report the 3 number result). i.e. a actual reading of 0.005 will be reported as <0.01. So technically the test cannot have a result of 0.000 because the equipment does not have the capacity to "see" a level of say 0.001 or 0.002.

Some interesting reading here:

www.prostatecancertopics.com/topic001.pdf

Best wishes,
Bill

Traveller58
Regular Member


Date Joined Mar 2013
Total Posts : 49
   Posted 3/17/2013 6:47 AM (GMT -6)   
Hi BillyMac,
Thanks for the information, I really appreciate it. My PSA results during the first 3 months were 0.002 and 0.003. After that I was on hormones for 15 months (including the 3 months period following the last injection) and all PSA results were at 0.003. Then I received RT so I used all my cards for a curative treatment! Apparently HT was masking the PSA during that period. The PSA tests after this period which I assume I was not protected by HT were all 0.003 again. My last PSA test was 4.5 months after the HT period. Maybe it is a good idea to test the Testosterone level and see if it increased or not. I assume that if T level stays at very low levels your PSA will not increase even if you are not on hormones. What do you think?
All the best
Traveller

Post Edited (Traveller58) : 3/17/2013 5:52:48 AM (GMT-6)

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