Question about PSA rise after surgery

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Date Joined Nov 2009
Total Posts : 7187
   Posted 12/24/2009 11:45 AM (GMT -6)   
Just curious:
I thought I read that 0.2 is kind of the danger point. If the PSA is >=0.2 after surgery, one should consider something like salvage radiation.
But with the super-sensitive PSA tests, I keep reading about folks who have 0.01 then 0.02 and then maybe 0.04. So now the PSA is doubling say every 2-3 months, yet it is below 0.20. In fact, I've also read that a PSA < .1 is often considered zero.
So, I'm confused. Can someone clarify. Is the above scenario a recipe for more treatment or is it still considered 0. I can see why the super-sensitive PSA can cause a lot of grief!
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10


Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 12/24/2009 11:51 AM (GMT -6)   
A whole lot of opinion is in these interpretations. I don't think you will find a document that says anyting less than .1 is undetectable, otherwise, they wouldn't detect it.

Maybe from a practicality and medical payout point of view, it is hard to attack every case that goes from .01 to .o4 to ???.

It seems from a logic point of view that any movement in the PSA upwards is indicative of something going on, if nothing less than a small portion of prostate that was left behind.

Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections

Regular Member

Date Joined Oct 2009
Total Posts : 310
   Posted 12/24/2009 1:28 PM (GMT -6)   
I can't speak to most subparts of your question, but I can say something from experience about the part where you say that <.1 is often considered zero.

At my cancer center those of us who are considered at relatively lower risk for biochemical recurrence are given the old standard PSA tests, which are less expensive than the super-sensitive PSA tests. I think it's also an issue re insurance reimbursement. Anyway, for the regular tests, the lower limit for detecting PSA is 0.1 ng/ml. Thus, a negative test result is <0.1 = "undetectable."

That's the way it was explained to me. Hope that helps, at least a little.

No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 12/25/2009 3:28 PM (GMT -6)   

The answers to your questions are tied to an understanding of the lower limits of the test methods.  You spoke of two different types of PSA tests, and the primary difference is the lower limits of the measurement capability.

Probably the most important thing to understand, first, is that there is no such thing as "zero" PSA.  The standard PSA test has a lower measurement limit of 0.1 ng/mL.  Anything less than that is not "zero"; rather, it is simply "undetectable."  Neurovascular nerve bundles, for example, will produce a trace amount of PSA, but below the measurement threshold of the standard PSA test.  If you read about guys joining the "zero club", this simply means they have PSA below the test measurement cabability...not really zero.

The ultrasensitive test goes roughly an order of magnitude lower, into the hundredths.  This test is newer and more expensive.  Some surgeons will prescribe the ultrasensitive tests after surgery, and particularly if they saw or have reason to believe there might be cancer left behind.  There is no "right" or "wrong."  If they do prescribe the ultrasensitive test, they are interested in getting a "track record" of PSA levels to see if it rises over time.  If it does start moving in an upward trend, then the patient will be better prepared for planning SRT, salvage radiation therapy.  Some surgery patients will have measurable levels of PSA on the ultrasensitive test; other patients will be below detectable levels.

There is no threshold set in concrete when all medical professionals agree that biochemical reoccurrence has taken place, but you are correct in understanding that the most commonly agreed level is 0.2ng/mL.

Does this information help?

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 12/25/2009 4:47 PM (GMT -6)   
As Casy explained there are different sensitivities of testing which came about as equipment improved. It's probably easier to think in terms of the original equipment as the "standard" test which could only detect levels above 0.3 (therefore if PSA was not detected it was reported as <0.3). I don't believe this level of testing is used any longer. The equipment was later much improved and gave a 10 fold increase in sensitivity. Think now of it as the "sensitive" test. This could detect PSA down to .03 but again if PSA was undetectable it technically would be reported as <0.03. In the late 90's the equipment was much improved again with a further 10 fold increase in sensitivity over the "sensitive" test. Now we're talking "ultra-sensitive" test. This can detect PSA down to .003-------if PSA is not detected it technically should be reported as <0.003. But each of these test levels was prone to a slight degree of error therefore it is common to see the sensitive test, if nothing is detected, reporting (for accuracy's sake) as <0.1 (undetectable) while if the the "ultra-sensitive" test is used and nothing is detected it is common to report it as undetectable i.e. <.01 (sometimes this also is simply reported as <0.1). Action (additional treatment) is not usually undertaken until there is clear evidence of an increasing PSA above 0.1. However there is an argument that such a recurrence could be observed much earlier as a steadily increasing PSA at the ultra-sensitive level.
There is a bit of reading here:

under the headings "what is an ultra-sensitive PSA test" and "expected PSA levels after RP"

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
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey:

Post Edited (BillyMac) : 12/25/2009 3:54:38 PM (GMT-7)

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