The dreaded ultra-sensitive PSA test revisited

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CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 3/26/2009 11:00 AM (GMT -6)   
It's been almost a year and a half since my surgery. As shown in some of my previous postings, I have anxiety over follow-up PSA tests. I had tried unsuccessfully to find a urologist in my area (not that I did an exhaustive search) that uses the "standard" PSA assay with sensitivity threshold of 0.1ng/ml. Although my latest result is very low, it is still trending up. The pattern is:
 
<0.008      <0.008       0.01         0.01          0.02
 
Based on my final pathology, my odds of having a recurrence are extremely low, but nevertheless I worry about this.
 
Has anyone else experiences these kinds of fluctuations with their ultra-sensitive testing. I will remain vigilant, but I guess I am looking for reassurance. Thanks
 
CaPCa
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.
03/23/09  PSA: 0.02
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 3/26/2009 11:26 AM (GMT -6)   
CaPCa...hmmmm...it really is too bad that you have the anxiety over the PSA ultra-low tests. The 1/100 change is so small of a fluctuation that it is impossible to conclude that it is rising or falling from the base line. Too many factors come into play at that level to assertain that this is anything but lab variances.

Gosh...I wish there was a way for you to not stress over such low amount of change...either up or down at that level. Try just looking at the first digit on the right side of the decimal point...which is zero...which is exactly where you want to be.

Congrats on another ZERO test!
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


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 3/26/2009 12:49 PM (GMT -6)   
I don't really see a trend. What I see is a different assay being used or a tad of prostate tissue. Don't forget, use the same assay and lab every time. Don't forget, there are no absolute margins around the whole the prostate. Then there is the cowper's gland. Teenie amounts of PSA will be present.

Swim
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/26/2009 2:31 PM (GMT -6)   
I see you as a guy that it is still pulling real strong Zeros. Don't let the microscopic fluctuactions of the tests throw you off base. There can always be some clinical or even hardware reason why there would be minor variances like you report. I think you are doing well.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 6 month on 5/9
 
 


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 3/26/2009 3:52 PM (GMT -6)   
When we had the same sort of questions and trends in the ultrasensitive PSA, the advice from Swim and others was reassuring (see signature). Although we did go for one re-test (same lab) my husband is confident he is showing a good post op result of zero thanks to members here and subsequent advice from surgeon. He had a rise from .01 to .02 which has stayed same since but it did worry us a lot at the time (in fact each test itself is a huge stressor). We were reassured by the comments of others about this issue however - I hope you are too. BillyMac also had some good information in back posts about sensitivities (and possible human carelessness) in callibration of highly sensitive machines used,  so maybe you could also have a look at some of these previous posts and compare it to your situation. It might help ease your mind as it did ease ours. Good luck and good health to you. We believe you can celebrate another solid zero!

Creed_three
Husband 51 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery (< 0.1) specifically,  
June 2007: 0.01; Oct 2007: 0.02; April 2008: 0.02: October 2008: 0.03: November, 2008 (repeat PSA with instructions to lab to calibrate carefully) = 0.02.
 


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 3/26/2009 7:46 PM (GMT -6)   

Thanks for the words of encouragement - it really, really helps. It is especially helpful to see the PSA numbers of others.

I have posted on this before, but I may again consider searching out a urologist who uses the "conventional" PSA test with a sensitivity threshold of 0.1. While attempting to switch assays earlier, I personally found a general lack of knowledge surrounding PSA tests and statistics in the medical community. I guess the type of information that I and some others are looking for comes from research scientists/doctors and statisticians, more so than the urologist/GP/nurse who is on the "front line", at least in my opinion. As others have experienced, I have had PSA numbers reported to me incorrectly on two occasions, as if there is not enough anxiety and uncertainty already. This time, I may first at least wait until I (hopefully) see a plateau or reduction in an ultrasensitive test result, and then switch doctors to go for the "conventional" test.

Does anyone know of a urologist in Silicon Valley that uses the "conventional" PSA test?

Thanks,

CaPCa


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.
03/23/09  PSA: 0.02
 


Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 3/26/2009 8:41 PM (GMT -6)   
CaPCa,

My PSA has been jumping around for 2 1/2 years now and I've gotten used to the discrepencies. I went back and looked at all my numbers and this is what I got: 0.01, 0.1 (different lab), 0.02, <0.01, 0.04, 0.02, 0.03, 0.03, 0.03. All four of my doctors say undetectable don't worry about the minor differences.

Ken
Age 54 (2006)
PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06
Memorial Hospital, Pawtucket, RI
Post-Op Biopsy, Gleason 6 (3+3), T2c,
right apical margin positive
CT Scan 1/07, tumor discovered on right
kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07
R.I. Hospital, Providence, RI
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 11/08 - 0.03


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 3/27/2009 8:18 AM (GMT -6)   
CaCPa,

My six week PSA was taken at a the Fred Flinstone Lab <.1, Doc said get a better lab, then 4 month PSA taken a distance away from home (too far to keep driving) at a John Wayne Lab <.05 and then I found a Lab near home I would use for conveinance sake which was a George Jetson space age Lab for 6,9 and 12 month PSA's that were .01, .01. and <.008. And then I said hey, wait a minute .01 then .01 then <.008 what the heck? Does this mean I had a reading at 6 and 9 ?

I told my concerns to my Doc, and he looked at me long and hard giving a little exhale of his breath, I waited , he paused, and then he spoke... Listen he said, stop watching so much darn television and just go fishin, they have all been zeros as far as I am concerned, be gone.

I am a little behind you in time from surgery and I feel just like you do. Hard to not feel that way. I got to say though being from the Midwest I think a lot more about it when I am stuck inside watching it snow. Taking my mind off of it really does help. I fish spring, summer and fall. I dont Ice Fish in the winter for my wife is not that ugly.

Frank
Age 54
DRE normal , 2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
PSA @ surgery 6 
Bone and Ct scans negative
clinicaly Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008, University of Chicago.
Catheter out in 7 days normaly expected leakage
Post Pathology T2C, Gleason 7, (3+4) 10 % of both portions of prostate
Seminal vessels clear, fat tissue clear, single positve margin at apex measuring less than 1/2mm. 
PSA Six week < 0.1 4 month PSA <.05 6 month PSA<0.01,9 month<0.01,12 month <.008
Watching PSA @ 3 months for 2 years,  will do salvage radiation if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. 
 

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