PSA Test Standardization

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Regular Member

Date Joined Sep 2007
Total Posts : 28
   Posted 10/17/2008 6:49 AM (GMT -6)   
   Just got back results from the latest PSA test.  This is the second time that I have used this lab and the results are the same as last time, "0.1".
When I was first tested after surgery, the lab results were reported as "<0.1" which is what I had hoped for and expected.  Then at the 6 month test I used another lab that was closer to home.  The results came back as "0.1".  This caused some questioning on my part as well as the nurse and doctor's part.  This last test @ 9 months I figured that I should stick with one lab to make sure that the test was being run with the samee standards as before.  The results came bask as "0.1" again.
Here's the part that bothers me based on everything that I have read from fellow members of this forum and test results from around the country and the world.
 Printed on the test results was this paragraph;
    "According to the American Urological Association, PSA should be undetectable after radical prostatectomy.  A PSA of less than 0.5 ng/mL (or undetectable) is not likely to be associated withe disease recurrence within five years of treatment.  Values obtained with different assay methods or kits cannot be used interchangeably.  Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease."
Under 0.5 is undetectable?  What gives here?  Has anyone else ever seen this on their lab test report?  I wish labs would use the same test so that you could be more assured of state of your body.
Age- 59 @ Diagnosis
Diagnosed July 2007
PSA-4.0 (Free psa 11%)
Biopsy August 2007 - 2 of 4 on Right Side with 20%, Stage T1c
Gleason (3+4)
Cat Scan & Bone Scan both Clean
DaVinci Surgery Nov. 26th RWJUH Cancer Center, New brunswick, NJ
11/27/07  Home & on the road to recovery
12/4/2007 Catheter Out!
Pathology Report:  Gleason 3+3=6
                          Stage   T2c
                          Organ contained Negative Margins
1/1/08  Back to Officiating Wrestling
2/27/08 1st Post Op PSA...<0.1 Undetectable
Still using a pad everyday for minor leaks (using Detrol for bladder spasms)
4/1/08 Trying Levitra every other day  very little response :(
5/6/08 Stopped the Detrol....Didn't help anyway.
Response to stimulation getting better for Mr. Happy
5/30/08  PSA...0.1
9/22/08  PSA...0.1  Still minor leakage  ED getting better

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 10/17/2008 8:35 AM (GMT -6)   
I believe the above quote is in correct. I went to the AUA website and pulled this information:

Definitions of biochemical failure for patients treated with radical prostatectomy:

"Detectable PSA post-prostatectomy or a rise in PSA levels > 0.2 ng/mL for radical prostatectomy patients and two consecutive rising PSA levels after nadir for radiation therapy patients"

This was a direct quote from the AUA website. Looks like what was printed on the lab report is a bit misleading and misquoted and I would ask them to recheck their source.
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
14 tumors in prostate - largest being 6 cm 

Regular Member

Date Joined Jun 2008
Total Posts : 407
   Posted 10/17/2008 9:53 AM (GMT -6)   
Interesting that you've raised the question, because I've been thinking about it these past several weeks. Why not just stick to the same lab, which should be using the same consistent standards for testing - instead of moving around?  
My primary care physician - who was doing my PSA tests for the past 8/9 years until the point he was (correctly) suspicious that I had prostate cancer - used several different laboratories over those years to process the tests. These labs were and are less expensive for the physician to use than if he'd used the laboratory of the hospital with which he's affiliated and at which I had my prostate surgery in September of this year. 
With his suspicion raised, my physician conducted a second PSA test - and had it processed by the hospital laboratory, for comparison purposes. 
Now that I've had my post-op PSA test (0.0), a test which was conducted at the hospital, I will continue to have the PSA test processed by the hospital laboratory in years to come . . . so that I have some better degree of assurance and comfort that the same standards are applied and the results will be more accurate. 
I may be more fortunate than many other guys, though - that I live in the same city as the hospital and it's easy for me to get to/from the hospital for testing.
All of this - good 'food for thought' as we go forward.  Thanks!

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (19 days post-op)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)


Tim G
Veteran Member

Date Joined Jul 2006
Total Posts : 2359
   Posted 10/17/2008 10:28 AM (GMT -6)   
Individual laboratories may change their test methodology and test manufacturers, so there is no guarantee that these will remain the same for an extended period of time. In fact, this is common practice in laboratories based on price considerations, ease of testing, and advances  in test methods. 
There is also  normal test variation, so that the same test run multiple times may yield different results within a range.  Test variation may also occur when different technicians perform the testing.  The concept of accuracy in laboratory results is based on an acceptable statistical range of test results rather than an absolute number that never varies.   

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 10/17/2008 5:55 PM (GMT -6)   
You should probably make sure that you use the same lab for your testing but I for one would not be happy with that report format. Sometimes these labs have their way of doing things and can be stuck in a time warp with outdated methods (especially in reporting styles). As has been mentioned, using various labs (who may use different assays and techniques) may yield erratic results written in different formats. The whole idea of PSA testing is to give you an idea of what is, or is not, going on within. I personally am a fan of ultrasensitive testing (who would have thought?) based on this study and report.

Ultrasensitive testing gives you an absolute baseline following surgery or radiation and can give an earlier indication if relapse begins to occur. Action may or may not be taken at these levels but a future course of action can be planned. There are many out of date reports out there so perhaps one that classifies <0.5ng/L as "undetectable" is one of these.
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 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

Post Edited (BillyMac) : 10/17/2008 5:01:23 PM (GMT-6)

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