Need advise on interpreting latest ultra-sensitive PSA result

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CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 7/30/2008 5:16 PM (GMT -6)   
I just got my 9-month post-surgery result back, and the total PSA is "0.01". The last two tests came back as "< 0.008". The same lab was used, and I believe the same assay was used as well. I know from my previous research that the assay results are not terribly accurate at their limit of detection, which is 0.008 for this particular assay. I sure wished that it came back as "< 0.008" again. Should I be concerned, or is this most likely "background noise"? Thanks
 
CaPCA
Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
03/17/08  Erection quality mostly back to pre-surgery levels with Cialis;
              have not tried without meds yet.
04/23/08  Second post-surgery PSA result: < 0.008 ng/ml
 


Guy66
Regular Member


Date Joined Jul 2008
Total Posts : 32
   Posted 7/30/2008 5:32 PM (GMT -6)   
My doctors told me that most labs use <.01 as the standard for no measurable level of PSA. So I was very pleased to go from 14.6 to <.01 on my first post op test (the ultra sensitive test). One can never be absolutely certain they are cancer free based on any blood test. But I believe the odds should be vey much in your favor.
Guy 66
first biopsy was in 1997. Neg. Dx BPH PSA 5.4
second biopsy in 2001 neg again PSA 9.8
passed blood Feb 08 3rd biopsy positive PSA 14.6 Gleason (3+3)=6
Pre op Xrays, CT scans, bone scans all neg
Da Vinci surgery 3/3/08 no complications, nodes clear
Significant post op discomfort for approx one week
Daily improvement 2nd week, near nornal mobility, etc 4th week
Filled pads every 2 hours for first month, gradually improved to not wearing pads after 2 months. Whoopee!
Occasional small leak when sneezing or farting, haha
Total loss of erectile function so far, some loss of rectal muscle function also.
Currently back to 100% physically, working out, etc.
Some lingering attitude issues over lack of function. Anger sometimes, moderate depression sometimes. Feel good physically but lingering changes in emotions. Joi da vie not the same. Feel lucky overall, but emotionally flat. A vague sense of loss, diminished pleasure in life. Hope to rebound as time goes by. Survived melanoma in 2000, pacemaker in 2002. Three time winner? Doesn't feel that way.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 7/31/2008 6:52 PM (GMT -6)   
Hello CaPCA,
The hyper sensitive and ultrasensitive tests are just as their name implies. It is my understanding that the sample is run through the testing equipment 3 times and an average taken as at such extremely low levels there are slight variations each run. Your initial reading of less than .008 is essentially 0. Your following reading of .01 is only 0.002 higher which is infinitesimal and completely meaningless ............... don't at this stage worry yourself and believe it is increasing. There are a couple of other organs in the body capable of producing minute quantities of PSA (I don't understand why it would be designated Prostate Specific Antigen in this case though ............... I suppose it must be chemically identical and thus registers on the equipment despite being from a different source). Congratulations on the great news, go with the flow and "Keep on keeping on"
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 <0.1 undetectable

Post Edited (BillyMac) : 7/31/2008 6:58:59 PM (GMT-6)


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 7/31/2008 10:42 PM (GMT -6)   
Thanks for the words of encouragement. I think I let myself get too optimistic with my initial two readings and rapid recovery in other areas. I would like to get this prostate cancer behind me as quick as possible. However, I have to be realistic - even if had another "<0.008" reading, I would not be "out of the woods".

Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
03/17/08  Erection quality mostly back to pre-surgery levels with Cialis;
              have not tried without meds yet.
04/23/08  Second post-surgery PSA result: < 0.008 ng/ml
07/30/08  Third PSA: 0.01 ng/ml
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 8/1/2008 8:34 AM (GMT -6)   
My thoughts are, until you have two consecutive rising PSA's, that any small rise is background noise. My father's PSA scale goes down to <.02, therefore, you are still undetectable according to his. I know it is scary to see any movement in an upward direction, but stay positive and we will hope and pray that the next PSA is <.008.
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
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 8/1/2008 1:19 PM (GMT -6)   
there are some papers out there that define biochemical recurrence with an ultrasensitive test as three consecutive rising values, regardless of absolute level. Others, like Dr. Patrick Walsh, dismiss anything below 0.1 as being insignificant. After surgery, I had originally requested the "standard" PSA test in hopes of avoiding such anxiety, especially since my final pathology was very good. Evidently, my urologist's office either doesn't offer the standard test or misinterpreted my request. I think it's too late to switch to the standard test now so as to avoid inconsistencies.

Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
03/17/08  Erection quality mostly back to pre-surgery levels with Cialis;
              have not tried without meds yet.
04/23/08  Second post-surgery PSA result: < 0.008 ng/ml
07/30/08  Third PSA: 0.01 ng/ml
 

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