Variations in post-surgical PSA

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Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 2/6/2009 5:00 PM (GMT -6)   
I posted something about this, albeit in a slightly different vein some weeks ago, but after three post-surgical PSA's (following RRP 12/07) of <0.01 I had the latest come in AT 0.01, which true to the stories of ultra-sensitive test anxiety, has had me a bit anxious. My doc wanted to simply test routinely for my next regularly scheduled appointment in six months. After considerable brow furrowing he "compromised" and gave me a lab form for three months (late March). The more I thought about it, the more steamed I got, and decided to take matters into my own hands, since I am of course the one ultimately responsible for my own treatment. I called my GP and had him write a lab request (same lab I always use) and had blood drawn today. I'll either be relieved if it comes back at <0.01 (and have a better February and March) or see "the truth" and begin preparing for what may be the next step of this fiasco.

Now that I'm off my soapbox wink has anyone else had their "ultra-sensitive PSA readings fluctuate, and how much?
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, bladder resection margin, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01
Forth (one year) PSA 0.01 (not less than)
Re-test in March


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 370
   Posted 2/6/2009 5:58 PM (GMT -6)   
No, I haven't had your experience yet, My first post-op PSA was=.01, the next one was <.01. I am very nervous and anxious like you but remember, most urologists won't recommend salvage radiation until your PSA rises close to .1. So there really is nothing you can do about this now, just keep getting retested until a pattern is determined. I already have the radiation center picked out that I'll go to if my PSA gets close to .1. I feel that is about as prepared as I can be for this possible outcome.  But that's about all you can do for now. Ain't prostate CA great!

montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 2/6/2009 7:41 PM (GMT -6)   
I just got another PSA done this week because the < was not there in December, my 2 year PSA in December came back 0.04 instead of the others which have come in at <0.04, not a lab error as computer prints out results during the testing, so naturally with my pre-op findings I was worried that it might be going up. The one that came back today had <0.04.
diagnosed sept 2006 @ 54 years old, live in Georgia, gleason 3+4=7, (r) lobe only

psa 4.7 (psa rose 1 point per year for 3 years, urologist said still under 4 and no concern. If I can find out about PSA velocity, why didn't he know!)

Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT

RP Emory Atlanta December 2006. Path-negative margin, negative lymph nodes, negative SV, both Lobes involved
multifocal perineural invasion, Gleason 3+4=7

Fully continent 2 weeks post catheter removal

1st psa April 2007-<0.04, 6 mos-<0.04, 9 mos <0.04, 1yr <0.04, 21 mos <0.04, 2 yr 0.04 (rising?)


Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 2/6/2009 7:53 PM (GMT -6)   
Thanks fellas...

Clearly there is some "slop" somewhere in the whole procedure, as digging on the net I have found several testimonials about similar variations. One guy has a 5 year history with variations of over .05 on tests done at the same lab with the same assay. He had over a year at <0.01 then it came back up and then down again. I read a medical journal report thick in math that I mind-dumped years ago that inferred several causes of variation in readings, mainly involving the equipment and it's calibration.

We'll see what mine comes in at next week, and I'll post the hopefully favorable news when I get it. Either way, I'll bet $100 that if my urologist had this curse he would have re-tested himself immediately, and not have waited six months. Personally I loath hypocrisy as much or more than most other human faults.

I guess I have a bad attitude rolleyes
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, bladder resection margin, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01
Forth (one year) PSA 0.01 (not less than)
Re-test in March


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/7/2009 2:33 AM (GMT -6)   
Jetlagged,
Here are a couple of links discussing ultrasensitive PSA testing including the YANA input
www.yananow.net/UltraPSA.htm
www.phoenix5.org/Basics/PSAundetectable.html
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)


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 2/8/2009 1:09 AM (GMT -6)   

I have posted a number of times on my travails with the ultrasensitive tests. Your numbers are very similar to mine. You can search for my earlier postings, but I have concluded that there is nothing to worry about at these low levels. You have more to worry about regarding lab equipment calibration and misreads of results by doctors rather than any meaningful increase at this time.


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
11/04/08  One year PSA: 0.01
              Still taking 10mg Cialis every other day - enjoying the results
              too much to stop yet.
02/07/09  Taking 5mg Cialis every other day - having too much fun to try
              to stop for now.
 


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 2/8/2009 9:22 AM (GMT -6)   
I worry as well for each test. At the 6 month reading the doctor said undetectable. I asked for the exact amount. He said it was as low as the machine would go (<.04). At the 9 month mark doctor said undetectable and I didn't ask what the reading was since it was as low as the machine would go.

Let us know what the results are. However, I don't think you have a bad attitude. I think you have a need to be exact!
 
Age 48
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
surgery may 9, 2008 - houston, tx
pathology report -gleason 8
margins clear
9 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue


Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 2/8/2009 1:40 PM (GMT -6)   
Assuming that I see a favorable (and by that in my case I define favorable as <0.01, YMMV) number from my own "maverick" test, I am going to have a detailed discussion with my urologist/surgeon about the accuracy (or lack thereof) of these tests, as well as his (to me at least) cavalier attitude about the effects of the ambiguity. As I said, I'd bet any amount of money that if he were me, he would have been in the lab screaming STAT for another test the same day, yet he in effect shrugs his shoulders and tells me to re-test in 6 months. As we all know first hand, when it comes to your body, one's mindset is as if not more important than the clinical issues, and at least some of them clearly either don't care of forget that.

I forget the name of it, but there was a movie many years ago, where the lead played by William Hurt (who I think was an oncologist and/or surgeon and a stark raving jerk) gets throat cancer and goes through a metamorphosis, actually becoming human. Like all other walks of life there are all kinds, and perhaps many of these guys should have gone into pure research because they have poor or no human skills in the most human of endeavors.
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, bladder resection margin, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01
Forth (one year) PSA 0.01 (not less than)
Re-test in March


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/8/2009 2:11 PM (GMT -6)   
I like the mavericky idea on finding out things we need to know as patients, whom cares the most about ones own outcome??? I got mavericky a few times in the 2nd opinions arena and fired a few docs, one of them 1-2 days before radiations were to start and totally glad I did (hind sight now). I noticed she also was no longer at that facility 1- year later (hhmmm), and she was untruthful to my questions (2 of them)....she looked good however so if it were the flu she would have made a sale.

Did a psa test thing (mavericky) just recently, but I am not a post surgery patient, but just to see if Psa numbers would be about the same...got two psa tests on the same day and only about 1-2 hours apart, the results: .61 at the first one (Abbott) assay and .50 at the second different lab (I would have thought they would even be closer as I am patient on DES drug therapy and just would not guess that fluctuations would be that much when under drug useage, without drugs yeah psa's fluctuate alot every hour and day). I did not do any activity or work, just from one hosptial to my onco-docs clinic location. Atleast with a third psa from this first lab, psa dropped to .36 more recently, this is why psa history and velocity etc., is what we need to look at. It is different for a post surgery patient and post radiation patient or cryo etc.
 


Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 2/9/2009 11:18 AM (GMT -6)   
Well...

Got a call from my GP, and it's still AT 0.01 (not less than), using the same lab as always which uses the Beckman Coulter assay. So apparently something is causing it to be somewhat elevated, be it residual prostatic tissue or as some sites suggest another mystery source, or of course Pca.

Happy Monday rolleyes
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, bladder resection margin, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01
Forth (one year) PSA 0.01 (not less than)
Re-test in March


Jetlagged
Regular Member


Date Joined Jul 2008
Total Posts : 29
   Posted 2/9/2009 4:32 PM (GMT -6)   
While there are no doubt more sites to surf on the subject, I thought why not go to the likely best resource.

There are several remarks about "other" sources of PSA, I was wondering if anybody has read exactly what those sources are, as I can't seem to find any information about it.

Also, I have seen remarks that nobody would nuke me until it hits 0.1, but is there an acceleration towards that number that would inspire them to act prior to that point. My doc said that the "survivor rates" if it's nuked by 0.1 (assuming that it didn't start rising before the first year) are 90%. Is he just pulling numbers out of his posterior, or is there actual data?

I'm starting to wish I stuck with the 0.1 threshold tests.
Robotic RP 12/07
Age 46
Pre-surgical PSA 5.02
Bone scan/Chest X-ray clear
All margins, seminal vesicles, bladder resection margin, 17 lymphs clear
3+4=7
Three Post-surgical PSA's <0.01
Forth (one year 12/08) PSA 0.01 (not less than)
Fifth (on my own initiative 2/09) PSA 0.01


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/9/2009 4:37 PM (GMT -6)   
I have never had an u/s test and do not intend to. I do not see broad support for it in the literature. Why don't you ask for a standard sensitivity test to be done with the same draw as the u/s test and do your own comparison?

Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/9/2009 4:42 PM (GMT -6)   
Hmmm...everything I read is the magic number should be .2 before beginning SRT. However if the doubling is less than 6 months it might be done sooner. I only know of one individual that had SRT at .11 Even if the PSA rises to .1 it can hold there and never rise after that. That is why most oncologist want to wait for the .2 mark before beginning any definitive salvage treatment plan. From what I read, SRT has the best outcome for cure if started before it reaches .5 and anything after 1.2 SRT usually isn't going to cure the disease.
You are beating back cancer, so hold your head up with dignity
 
Les
 
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
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


Tobmeister
Regular Member


Date Joined Jan 2009
Total Posts : 41
   Posted 2/9/2009 9:14 PM (GMT -6)   
Jet - you definitely need to have an attitude to stay alive sometimes. Believe it or not I wouldn't even know I had cancer at this point if I had listened to my GP. In November he wanted to wait and recheck PSA in a couple of months. Even .01 you got I don't know that I would trust as it still might be off and hopefully < soon.
Tom, age 51
Diagnosed 11/12/2008
PSA 2006 - 2.8, 2007 3.06, 2008 4.6 (remember the rate of increase is as important as the level), PSA free 8.7%
Family history - brother and uncle (remember family history is very important)
Gleason score 7 (4+3); 6 out of 19 cores sampled positive for cancer; perineural invasion present
Bone scan and CT scan both negative
Prostate mildly enlarged, DRE negative
DaVinci radical prostatectomy 12/30/2008 - left side nerves spared
Catheter removed 1/15/09 - no pain!

Post operative results:
Pathologic stage - T3aN0Mx
Post surgery biopsy - Bladder neck margin negative, lymph nodes negative, specimen confined, extracapsular extension positive, perineural invasion positive, seminal vesicle invasion negative, all margins negative, Gleason 3 + 3 = 6.

No incontinence problem within 1-2 weeks after catheter removal
1st post op PSA scheduled for 4/16/09

"Pick a good doctor and say your prayers"


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/10/2009 7:21 AM (GMT -6)   
Les, your post right above, is along the lines of what my dr told me yesterday, and I tend to believe him as well.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 370
   Posted 2/10/2009 9:01 PM (GMT -6)   
 Regarding other sources of PSA, when my first post-op PSA came back at =.01 my urologist said the bulbo-urethral glands can secrete small amounts of PSA and not to worry. Concerning when to begin salvage radiation therapy with rising PSA, some guy on another blog quoted a study showing men who began SRT before PSA reached .1 did better than those who waited to after that level. I don't know where he got that info, I can't confirm the study anywhere.................prostate CA survivor
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