My ultrasensitive PSA test journey ends

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CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 6/22/2009 9:18 PM (GMT -7)   
As I have posted before, I have been strongly considering a switch to the "standard" PSA test. I was fortunate enough to have an excellent pathology, but this ultrasensitive test has caused me mild anxiety that never really leaves my conscious. I found a new urologist that agrees with me and uses the test with a "<0.1" sensitivity. Some may accuse me of shopping for the result I am hoping for, and while basically true, I have yet to hear a cogent explanation as to the benefit of the ultrasensitive test for those with a very low chance of recurrence after surgery. Had I had a poorer pathology report or was monitoring an already elevated level, I would probably go for the ultrasensitive test. For now, I am happy with my decision and am going to celebrate with a nice glass of red.
 
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 6/23/2009 5:43 AM (GMT -7)   
CaPCa...good news and I agree with the decision to stop the ultra-low tests in your case. Just goes to show you that dealing with cancer not only has to do with the disease, but the mental and emotional aspects as well. Too often men ignore the issues concerning their emotional well being and treat just the disease. I commend you for taking those measures to deal with this disease objectively.

Best wishes
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 6/23/2009 6:05 AM (GMT -7)   
I agree with you completely, I am overcoming a strong bout of PSA anixety right now as I write, it can be real mental and emotional torture, a sword over your head all the time.
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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 6/23/2009 6:37 AM (GMT -7)   

Gentlemen:

I concur with you all that there is some anxiety brought on by the PSA test. But, I have just had a follow up visit with my uro and my PSA was .36. (This is one year after the start of lupron therapy and nine months post IMRT.) Both my uro and oncologist are pleased with the current measurement and have told be not to get excited about the number. Apparently anything below a 1.00 and stable, emphasis on stable, is a good result. (I know that PSA after surgery should  be at non detect levels but the stability of the reading should also be taken in to account.)

Best of luck to all.

Don


Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
 
 
 


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 6/23/2009 6:48 AM (GMT -7)   
Not to be flip but on a more humoristic side I call this PSA testing journey "P.I.S.S."  PSA/Interval/Stress/Syndrome. 
 
I have had both tests performed from different labs.  All good results mind you, but each having their own little personalities. I have decided to try and have the same type of test from the same lab, done.  This way it reduces the little differences that seem to abound with PSA testing.
 
All the best,
 
Frank
Currently 55, surgery at 54
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 @ 6 months for 2 years,  will do salvage radiation if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. Tried Levetra about the same as Viagra.  Tried Cialis, think I will stay with the Viagra at 50 mg.  Side effects worse at 100 mg.  


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 812
   Posted 6/23/2009 8:45 AM (GMT -7)   
I had the same post op pathology as you.  I had surgery by Dr. Partin at Johns Hopkins.  They do not use the ultra sensitive test.  In fact if your first post-op comes back undetectable, they put people like us on yearly testing only.  We have a zero percent chance of dying from PCa in then next 15 years.  Even if we have reccurrence. 

41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 6/23/2009 9:38 PM (GMT -7)   
OK, I've had this on-going debate myself.  To do the Ultra-sensitive test or not. 
 
My regular physician's lab does the ultra-sensitive.  I've had it done several times.  My surgeon, Dr. Catalona in Chicago, does the standard and was one of the PSA pioneers.  He says the ultra-sensitive test is too "noisy" to be reliable.  Yet there are studies that show that ulta-sensitive tests can detect recurrence sooner and therefore increase the effectiveness of early intervention of radiation.  Yet no one recommends radiation until your PSA is over .1 anyway, so not sure I get that.
 
 All the PSA pioneers seem to be in synch that the standard test is still the one to follow...Partin, Walsh, Catalona.  I say, if the ultra-sensitive test causes too much stress, stick with the standard test. 
 
43 yo. now
 
5/07 PSA 4.65 at routine physical
6/07 biopsy Gleason 7 (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 - RRP at Northwestern Memorial by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op path report confirmed Gleason 7 (3+4). 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...
12/31/07 - threw out the pads (I only had used 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.
 
9/17/08 One year past surgery and doing well.  PSA less than .1 and ED continues to get better and showing reasonably good results using Levitra which for a long time did nothing. 

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