Fluctuating Ultra-Sensitive PSA

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Regular Member

Date Joined Jul 2008
Total Posts : 29
   Posted 3/12/2009 2:24 PM (GMT -6)   
Just in case anyone else ends up on my roller coaster, here's at least one example of a good outcome...

In December I had my one year visit following RRP and it's associated PSA draw. Much to my chagrin after three < (less than) 0.01 results using the Beckman Coulter assay, it came back AT 0.01. Now I know...several would kill for that level, but to me it seemed like I was heading for chemical failure, and you'll have to pardon me for not being too excited about the trend. My doctor said that it was well within the "margin of error" and that in his experience lab techs even leave off the < symbol either out of complacency or even that they somehow think they may have screwed up, or that the machine in use needed re-calibration. He said "not to worry" and that he'd re-test in six months. My other two uros I consult with said not to worry as well. My doc compromised and told me to re-test in three months instead of six. Beyond the fact that I seriously doubt ANY of them wouldn't have been in the lab for another draw yelling "STAT!!!" at the top of their lungs if it were them, my personality was tearing my mind a new one over the number so much that I went to my GP and had another draw done on my own nickle, and it came back AT 0.01 as well. Needless to say I was bummed out, although happy that it hadn't gone up. I just had my three month follow-up and this one (from the same lab using the same assay) come back < (less than) 0.01. Needless to say I am overjoyed, but I felt the need to post the result as living proof that there is "slop" in the tests in case someone else is in the same boat.

A good day for me indeed. turn
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
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

Regular Member

Date Joined Nov 2008
Total Posts : 65
   Posted 3/12/2009 2:54 PM (GMT -6)   
Hi Jetlagged,

I am a patient at M D Anderson Cancer Center in Houston. In 10 yrs I have never had an ultra-sensitive PSA test. I have asked both my urologist and medical oncologist why I never get the sensitive test. (I asked them both just for verification.) I was told that all the ultra-sensitive test does is create undue stress on the patient.

Treatment is not going to change unless there is enough PSA change to warrant it. With the ultra-sensitive test that is 10 times the change of the standard method.

Just as some guys have their PSA drawn every month instead of 3 months or 6 months, the stress level over a PSA can be unnecessary.
Don't misunderstand. There are times that a PSA every month are necessary and understandable.

Take it easy. Life is good.

Dx'd 1999, Age 60, PSA 43, Gleason (3+4=7), T3c
42-3d EBRT w/Lupron/Casodex for 24 months and PSA remaining to be <0.1 for the entire 24 month period.
July 2001 - 2nd opinion required to go intermittent ADT.
MDAnderson biopsy revised Gleason (4+5=9).
Intermittent ADT, Lupron only, with PSA threshhold established at 1.0.
March 2007 - Diminishing returns with Lupron, conferred with MDA urologist for bilateral orchiectomy. Uro asked for biopsy of prostate again. Biopsy resulted in tumors found with Gleason (5+4=9).
August 2007 - RRP and bilateral orchiectomy. PSA <0.1
99% continent immediately
September 2008 - PSA 0.45
November 2008 - PSA 0.67
December 2008 - Resume Casodex
December 2008 - Stricture in bladder neck requiring surgical removal. 99% incontinent immediately.

Life is not waiting for the storm to pass, it's learning to dance in the rain.

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 3/12/2009 4:14 PM (GMT -6)   
Hi Jetlagged,

The lab my doc uses doesn't measure anything less the .05 for this very reason...too much anxiety with the fluctuation in the PSA tests down that low. I think that is why most docs don't worry until it rises above the .1 mark so anything that is <.1 is safe. Hopefully in the future when the psa bounces around a little, you won't be so anxious as you were this last time.

Guess what....you're still in the zero club...and I bet many more zeros to come
You are beating back cancer, so hold your head up with dignity
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

Regular Member

Date Joined Dec 2008
Total Posts : 59
   Posted 3/12/2009 5:00 PM (GMT -6)   
I am also a patient at MD Anderson. Who are you seeing and what are your thoughts about the place.

Take it light

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 3/14/2009 12:19 AM (GMT -6)   
Hey jet!
You are right about two things, first that there is room for error in ultrasensitive testing. Mostly lab error, but there are times that an echo exists and causes a reading. I read that ladies can produce ultra low amounts of PSA that can be detected with these tests and that if we are talking about a hundreth of a point then it's useless information. Although it is possible to see trends over time with these tests, but Aspen nails it, why go through the aggravation. Most doctors won't take any action unless there is significant movement in the tenths and a standard Bayer Assay works just fine here.

Oh, yea the other thing you were right about: Indeed a good day for you. And glad to hear it...stay well and keep on keepin' on...


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
My Journal is at Tony's Blog  

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 3/14/2009 3:02 PM (GMT -6)   
That is the second lab error in the past couple of weeks around here. Sorry for the extra stress is caused, but thank goodness it was an error!! Congrats on the undetectable!!
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
Oct. 10, 08 PSA <.02
Praying for a cured dad.

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