What Defines Undetectable PSA?

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Psaltiri
New Member


Date Joined Apr 2009
Total Posts : 11
   Posted 7/17/2009 3:00 PM (GMT -7)   
I had my 6 week post-surgery PSA test yesterday.
 
0.004 ng/ml.
 
In the words of my daughter...  WHEEEEEEEEEE-HOOOOOOOOOOOOOO!!!
 
So, what level actually defines undetectable?  I've seen a variety of answers.
 
And honestly, I thought that 0.05 was the lowest the test would go...
 
What's the story?
Age 42 (DX at age 42)
03-25-09 | Routine annual physical, palpable lump on left side of prostate, PSA 8.8 (rose to 9.54)
                  My wife said to get the prostate exam - saved my life!
04-10-09 | Needle Biopsy - 12 cores
04-16-09 | 7 of 12 cores positive, Gleason 4+5=9
04-23-09 | Bone Scan, CT Scan & PET scan appear clear - no evidence of metastasis (WOOHOO!!!)
05-27-09 | Surgery - went well (first surgery ever!)
                  No lymph node involvement
                  No seminal vesicle involvement
                  Positive margins
                  Regraded to Gleason 5+4=9
07-17-09 | PSA 0.004
 
Amazing wife, 2 awesome children (ages 4 & 5)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 7/17/2009 3:10 PM (GMT -7)   
Congrats on a big major zero.

The answer to your questions varies much. I think the official answer is anything less than <.10.
Some people's come back to the 1/100th, i.e. .05 and your's came back to the 1/1000th, i.e. .004.

I have read lots of sources that feel that the ultra sensitive tests aren't all that accurate once you get into that range, and even day to day, there would be up and done flucuations.

The important thing, is you have a zero and welcome to the club. Hope you stay there for many years.

david in sc
Age 57, 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 capsule, one post. margin, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, they want to start radiation, 70 gray, I am still considering all options and opinions
 
 


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/17/2009 3:13 PM (GMT -7)   
I believe the "official" answer (so to speak) is 0.1. Purgatory's point is well taken, which I will paraphrase to say that anything below 0.1 is mostly laboratory noise.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 0.006


Psaltiri
New Member


Date Joined Apr 2009
Total Posts : 11
   Posted 7/17/2009 3:14 PM (GMT -7)   
Hey, as long as it stays below 0.1, that lab can be as noisy as it wants...

Happy to be a big, fat ZERO (reminds me of high school...)
Age 42 (DX at age 42)
03-25-09 | Routine annual physical, palpable lump on left side of prostate, PSA 8.8 (rose to 9.54)
                  My wife said to get the prostate exam - saved my life!
04-10-09 | Needle Biopsy - 12 cores
04-16-09 | 7 of 12 cores positive, Gleason 4+5=9
04-23-09 | Bone Scan, CT Scan & PET scan appear clear - no evidence of metastasis (WOOHOO!!!)
05-27-09 | Surgery - went well (first surgery ever!)
                  No lymph node involvement
                  No seminal vesicle involvement
                  Positive margins
                  Regraded to Gleason 5+4=9
07-17-09 | PSA 0.004
 
Amazing wife, 2 awesome children (ages 4 & 5)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 7/17/2009 3:16 PM (GMT -7)   
Congrats on the big zero.  Wishing you a lifetime of them
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
21 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/17/2009 9:54 PM (GMT -7)   
Hey Psaltiri,

Great news on the undetectable! May you have many, many more!

Kind regards,

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 7/17/2009 10:03 PM (GMT -7)   
Good One Psaltiri ! yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah
Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason 4+3=7 (60% Grade 4)
Stage T2c
Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week.
ED- taking Meds/ No results yet/still "NotHard"
PSA 1/09  .03
PSA 2/09  .03
PSA 5/09  .03
"Everyday in Everyway I get better"


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 7/18/2009 3:06 AM (GMT -7)   
Generation 3 testing came into use just before the year 2000. The test has a claimed lower detection limit of .003ng/mL. So strictly speaking if your PSA were below .003 it would not be detected therefore is "undetectable". The problem is that if you tested that same sample a number of times the results would vary considerably at the three decimal place level (it could easily register .003 on one run and .006 on another....... a 100% variation), so the test is said to have a functional sensitivity of .01ng/mL....ie. you are undetectable if you register less than .01 on Gen 3 equipment. This can be further complicated if the lab is using generation 2 equipment ( developed mid 90s) which has 1/10th the sensitivity of the later equipment (ie. a lower detection limit of .03ng/mL). Generation 2 has a functional sensitivity of 0.1ng/mL so if you are below this on that equipment you are "undetectable". I assume that to cover all bases it is acknowledged that you are undetectable if your PSA registers below 0.1.
Bit of reading here (under "what is an ultrasensitive PSA assay" ):
www.prostate-cancer.org/education/preclin/McDermed_Using_PSA_Intelligently2.html
By the way, after all that congratulations on being "undetectable"
yeah
Bill
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)
PSA February 09 <0.01

Post Edited (BillyMac) : 7/18/2009 4:15:19 AM (GMT-6)


london2000
Regular Member


Date Joined Jun 2009
Total Posts : 36
   Posted 7/18/2009 3:34 AM (GMT -7)   
A very good result, Psaltiri.

You ask what counts as undetectable. Speaking as a chemist who was involved with all sorts of analytical tests (but never with the determination of PSA levels), the limits of a test depends on the method of analysis that is used and the laboratory carrying out the test. As time goes on, new and more sensitive methods become available, but these have to be validated (ie, proved to be reliable) before use. The results from the validation show, amongst other things, how much statistical variability there is in the results from the repeated analysis of a single sample and therefore how much confidence can be placed in any particular finding. As you might expect, the lower the measured concentration, the greater the variability - what CapnLarry refers to as "laboratory noise".

The possible need to purchase new equipment for the more sensitive methods, plus the requirement for the validation of the new methods, means that it can take a long time for newer methods to become widely used so you have different laboratories reporting in different ways.

As I say, I don't have any experience of the PSA methods so I can't comment on what methods are available for its determination and how accurate and precise the different methods are. However, as David and CapnLarry say, while extremely assuring to get a very low PSA result what is more important is to get a result that has no clinical significance, and nowadays that is taken to be below 0.1 ng/mL for PSA.

Also, bear in mind that below 0.1 ng/mL is exactly what it says - the PSA level is somewhere below 0.1 ng/mL. It could be a hundred times lower than this but the test is not sensitive enough to report the result other than as being below 0.1 ng/mL. But you can be confident that it is less than 0.1 ng/mL.

Roger
Diagnosed with PCa in April 09, aged 59. PSA 9.5 ng/mL, Gleason 3+3, 3/8 cores positive on biopsy.

Had laparoscopic radical prostatectomy in 21 May 09. Histopathology raised Gleason score to 3+4 but cancer confined to capsule with surgical margins being negative. Stage T2c. Nerves spared.

Catheter removed on 4 June 09. Currently coping with incontinence issues, but making progress!


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/18/2009 12:03 PM (GMT -7)   
welcome to the club my friend. I pray you will have many years of zero's. Enjoy life

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 7/20/2009 7:15 AM (GMT -7)   
Psaltiri said...
So, what level actually defines undetectable?  I've seen a variety of answers.
 
What's the story?
I've asked my Surgeon / Urologist this same question several times and the answer he consistently gives me is that he and the hospital - Northwestern Memorial Hospital in Chicago - do not report beyond 0.0 - and that  they consider that level "undetectable."  Remember that different laboratories may report different testing results for the same sample and that what you may read from one person posting test results and sensitivity levels can be an 'apples to oranges' comparison with your situation.  I still wonder though . . .

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 (1/2 light pads per day)

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

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

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0

 


Psaltiri
New Member


Date Joined Apr 2009
Total Posts : 11
   Posted 7/20/2009 10:48 PM (GMT -7)   
Thanks all for the feedback. I'm happy it's low, and am not going to worry overmuch about the noise.

We're getting ready to start hormone therapy in early September, and will add adjuvant radiation probably in November. In the meantime, I'm hoping to take a jaunt out to the Netherlands to have the Combidex test. I just don't want to give this cancer any footing.

I'm even starting to see some real progress in the incontinence! The muscles are starting to "just work", and they even seem to work better if I don't try to "make them work", if that makes any sense...

I keep all in this "reluctant brotherhood" in my thoughts and prayers every day.

Be well.
Age 42 (DX at age 42)
03-25-09 | Routine annual physical, palpable lump on left side of prostate, PSA 8.8 (rose to 9.54)
                  My wife said to get the prostate exam - saved my life!
04-10-09 | Needle Biopsy - 12 cores
04-16-09 | 7 of 12 cores positive, Gleason 4+5=9
04-23-09 | Bone Scan, CT Scan & PET scan appear clear - no evidence of metastasis (WOOHOO!!!)
05-27-09 | Surgery - went well (first surgery ever!)
                  Positive margins, no lymph node involvement, no seminal vesicle involvement
                  Regraded to Gleason 5+4=9
07-17-09 | PSA 0.004
 
Amazing wife, 2 awesome children (ages 4 & 5)


london2000
Regular Member


Date Joined Jun 2009
Total Posts : 36
   Posted 7/20/2009 11:53 PM (GMT -7)   
Psaltiri said...
I'm even starting to see some real progress in the incontinence! The muscles are starting to "just work", and they even seem to work better if I don't try to "make them work", if that makes any sense...

I know what you mean because I'm finding the same. I thought I was going to have to walk around with my pelvic floor muscles squeezed hard for the rest of my life but, instead, I'm finding they can be relaxed and urine is still retained.

All the best, Roger
Diagnosed with PCa in April 09, aged 59. PSA 9.5 ng/mL, Gleason 3+3, 3/8 cores positive on biopsy.

Had laparoscopic radical prostatectomy in 21 May 09. Histopathology raised Gleason score to 3+4 but cancer confined to capsule with surgical margins being negative. Stage T2c. Nerves spared.

Catheter removed on 4 June 09. Currently coping with incontinence issues, but making progress!


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/21/2009 7:12 AM (GMT -7)   
Since everyone is being supportive and telling you not to worry I thought I would take the other approach. Given the rate of medical progress, when you are 80 years old your PSA is going to come back at 0.0000004 and you are STILL not going to know whether you should worry about it
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0


Psaltiri
New Member


Date Joined Apr 2009
Total Posts : 11
   Posted 7/21/2009 9:32 AM (GMT -7)   
Maybe so, geezer99, maybe so. But that's 38 years away, and PSA tests are not the only thing that will improve with our medical progress. There will be other advances as well, perhaps including full prevention, and even out-and-out cure...

But I'm sure I'll find other things to obsess about during that time... ;-)
Age 42 (DX at age 42)
03-25-09 | Routine annual physical, palpable lump on left side of prostate, PSA 8.8 (rose to 9.54)
                  My wife said to get the prostate exam - saved my life!
04-10-09 | Needle Biopsy - 12 cores
04-16-09 | 7 of 12 cores positive, Gleason 4+5=9
04-23-09 | Bone Scan, CT Scan & PET scan appear clear - no evidence of metastasis (WOOHOO!!!)
05-27-09 | Surgery - went well (first surgery ever!)
                  Positive margins, no lymph node involvement, no seminal vesicle involvement
                  Regraded to Gleason 5+4=9
07-17-09 | PSA 0.004
 
Amazing wife, 2 awesome children (ages 4 & 5)

New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, February 20, 2018 6:56 AM (GMT -7)
There are a total of 2,931,159 posts in 321,605 threads.
View Active Threads


Who's Online
This forum has 160343 registered members. Please welcome our newest member, Ear Doc.
417 Guest(s), 10 Registered Member(s) are currently online.  Details
JayMot, Froggy88, XX222, lazyminimoo, Bucko, GoHerd92, RandyJoe, doors12, Lynnwood, gumby44