Ultra-sensitive PSA test redux

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CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 9/15/2008 10:22 PM (GMT -6)   
As you can see by my signature, I was blessed with a very good post-RRP pathology: Gleason 6, 5% gland involvement, no capsular penetration and negative margins. My first post-op PSA was "<0.008" which is, of course, considered "undetectable". Statistically, I have something like a 1% chance of recurrence over the next ten years. Even with a great outcome and pathology, I still fight PSA anxiety and it is just part of my personality to worry about such things. I had originally requested from my urologist's nurse that I be given the "standard" PSA test, but alas, my request was either ignored or misunderstood and I received the ultra-sensitive variety. To be consistent, I have stuck with the ultra-sensitive test through the same office and from the same lab for the last three tests. The first two came back at "<0.008" and the last one was "0.01" which is still extremely low.
 
I am considering, in no small part due to a suggestion from my wife and counselor, that I try switching to the standard PSA test from now on. After all, that is what I had originally wanted. This would hopefully allow me to avoid seeing the background noise so common with these tests. I have read that the ultra-sensitive tests may give an earlier indication of a recurrence, however it seems that nobody would recommend adjuvant therapy unless the level were to reach 0.1 anyway. Therefore, it seems to me now that it has no real value in my case.
 
Has anyone else made a similar decision? I don't want to short-change myself and risk letting this disease get an upper hand, yet I know that emotionally I would benefit from not seeing the ultra-sensitive test noise. One thought I had was to switch to the standard test, yet test at 6-month intervals instead of the yearly intervals normally recommended at a year out from surgery. Your thoughts and advice would be appreciated.
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
 


Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 9/16/2008 12:43 PM (GMT -6)   
Given your pathology report I would not disagree with your logic.  Good luck on your decision.
Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03
 
PSA August 18th 2008 = .01 or less, test only goes down to .01


Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted 9/16/2008 6:21 PM (GMT -6)   
Sounds like a good plan to me.

Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 


41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 9/17/2008 7:35 AM (GMT -6)   

Interesting the ages on this thread so far...geez...aren't we the lucky ones...

Today is my one year anniversary and I've had 2 ultrasensitive PSA tests and one regular.  my first ultrasensitive was .04 then .02.  After my first i was a mess wondering why it wasn't .00something rather than .0something.  My surgeon, Dr. Catalona, one of the primary researchers of PSA, is fairly dismissive of the ultrasensitive PSA stating that the level of "noise" makes them yet fairly unreliable. 

I have read studies stating that the ultrasensitive tests are good predictors for recurrence, and I'm the guy who finds that stuff hard to ignore.  So I go to my regular physician for an ultrasensitive PSA and then to my surgeon for the regular PSA.  I guess I just need that extra information.

I have also read that early detection of recurrence (below .1) from 3 successive rises in PSA can also be used to determine the need for adjuvant therapy.  I suspect they will ultimately find, it they haven't already, a better outcome for earlier intervention. 

Ask me and I vote for the ultrasensitive test.  But the anxiety is real and accompanies the test.  But isn't that what Xanax is for? :)  Just kidding...sort of...


 
42 yo. now
 
5/07 PSA 4.65 at routine physical
6/07 biopsy positive for cancer...Gleason 3+4...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - Radical Retropubic Prostatectomy Surgery at Northwestern Memorial in Chicago by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
 
Post op pathology was Gleason 3+4 with negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
 
9/27/07 - Catheter removal...let the games begin...
 
12/07 - Threw out the pads.  I only had to use 1 pad per day for protection against minor drips. 
 
I started Trimix 8 weeks after surgery with success.
 
I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.
 
 
 


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 9/17/2008 2:04 PM (GMT -6)   
Thanks to everyone for their opinions  - I really appreciate the advice. I have also read about three consecutive readings in the ultra-sensitive range as a possible trigger for adjuvant therapy. This may be useful for someone who has had a positive margin or a high Gleason grade, but I question usefulness at very low levels, near the sensitivity of the assay, with a Gleason of 6. Suppose I were to see a sequence of PSA levels <0.008, 0.01, 0.02, and 0.04 - would any oncologist recommend adjuvant therapy in my case? Probably not, but seeing that sequence would drive me nuts. I failed to mention that my PSA velocity prior to surgery was relatively low: < 0.4/yr. Also, I have had an excellent outcome on the ED front and would hate to irradiate the nerves unless absolutely necessary.  You can tell which way I am leaning, but I would love to hear more opinions on this. I don't want unnecessary adjuvant therapy or emotional distress, yet I don't want to bet my life on filtering out information, either.

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
 


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 9/21/2008 10:01 PM (GMT -6)   
I don't have the most recent edition of Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer." Does anyone know if he still is against the ultra-sensitive version of the PSA test after surgery? Thanks
 
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
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2285
   Posted 9/21/2008 10:26 PM (GMT -6)   
I personally want only a standard PSA test done, because below 0.1 is considered undetectable.  So that's what my urologist has had done for each of my post-prostatectomy PSAs. 
 
I'm in the same boat as you, with a low probability of recurrence. I am  thankful for a good primary care doc who sent me to a urologist when my PSA velocity increased fourfold over a year's time, despite the absolute number being in the normal range.
 
If I had a doc who waited until the PSA value was above normal or opted to ignore it because he couldn't feel anything on the DRE, it could have been an entirely different outcome. 
Age 59  PSA quadrupled in 1 yr (0.6 to 2.5) 
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 2006 
Organ confined pT2a  Gleason 5   
Cancer-free for 2 years  PSA's undetectable 

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