It was on again this PSA test. I first learned of the ultra sensitive PSA test on this forum about
six months ago and subsequently did a bit of research on it. Following my op in August of 2007, all the subsequent test results up to and including January 2008 were shown as <0.1 undetectable. No doctor or specialist including the surgeon mentioned the existance of an ultrasensitive test or its pros or cons. Based on what I learned here at the end of March I asked my G.P. to request an ultra sensitive result on the blood test. He in all honesty admitted he did not know of the ultrasensitive test but ordered it for me anyway. Test results came back ............. <0.1 undetectable. Good news indeed but can't they read? I have posted before on the forum about
the back and forth exchange that took place with the pathology lab and their failure to show the 3rd Gen test result which was clearly requested. Answers of "you don't need it" and "we are following reporting protocols" were proffered. Of course I had to initially argue with the first line of defense (telephone receptionist), who when I would not accept her offerings (all the while she had no idea of what she was talking about
) then passed me to the complaints department where we went through the whole process again. With me still not being a happy little vegemite she surprisingly passed me to the lab pathologist and we also conducted a little to and fro. The final upshot....................they actually run all PSA tests on generation 3 equipment (and have done for over 5 years) which produces a 3 decimal place result which, because of convention, they report only to one decimal place. Pre-prostatectomy or post-prostatectomy, regardless of the need, you're getting the same result boy so be happy with it. Anyway, my obvious displeasure at the time had the desired effect and they went back and checked the records for the complete reading and reissued the report ............ <.001 undetectable... oh happy days. That was March. Fast forward to August's test. Ultrasensitive test requested and this time high-lighted ...............yep you guessed it .......result <0.1 undetectable. Now I was really cranky. Into the fray again. Exactly the same scenario, exactly the same defense and excuse making, battling through the same line of command. I even browbeat the pathologist with information on the patients need to establish his post-prostatectomy nadir level of PSA for future reference and had the report redone and re-issued ........... <.001 undetectable. Happy days again although somewhat tainted by this battle. I have prepared a letter for the lab and will include the following for them to read in order that they gain a proper appreciation of a PCa patients concerns. www.prostate-cancer.org/education/preclin/McDermed_Using_PSA_Intelligently2.html
Extract from the above linkExpected PSA Levels After RPPSA levels that are measured three or more weeks following a successful RP should be zero, or at least very close to zero, and stable. The presence of PSA in the blood after RP indicates a failure to remove the tumor completely, and the reappearance of PSA at a later date indicates tumor recurrence. Exceptions to this include cases where unilateral or bilateral nerve-sparing surgery or laparoscopic procedures leave benign tissue behind. In such patients, PSA levels will often be detectable using a third-generation PSA test, albeit at a very low concentration.
The functional sensitivity of the first and second-generation PSA assays significantly limits their use for early post-operative detection of surgical failure in most cases. However, a number of clinical studies have been published using PSA assays with third-generation sensitivity post-RP. These studies have clearly established the value of these highly sensitive assays for detecting early prostate cancer progression following RP. 18,19,20,21 In a landmark study by Witherspoon et al, DPC’s IMMULITE Third Generation PSA assay appeared to (1) identify men with apparently organ-confined prostate cancer destined to fail surgery and (2) provide an average 18-month lead time in detecting disease progression compared to a conventional PSA assay