PSA LAB TESTING DISPARITIES

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Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 1/5/2010 7:45 PM (GMT -6)   
On 8 October (8 weeks post RRP) my PSA was given as 0.02.  Today, from a different lab,(almost 16 weeks post RRP) the reported PSA is 0.09.  If this is true, my PSA has certainly doubled quickly so I'm wondering if there could be a disparity in lab testing procedures etc. If not, I should be thinking about IMRT - correct?  The Old Sailor
 
RRP 8/13 - Path report gleason 4+5, all margins, nodes, necks, etc. etc. clear.  pT2c.  Only perineual invasion present. 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/5/2010 7:58 PM (GMT -6)   
Old Sailor, is there any way you can get another test done by the original lab. My dr. told me its real important to have consistent lab readings, especially when dealing with post surgerical readings. We are talking about microscopic amounts here, but it is very important for it to be accurate. If it is truly a jump from .02 to .09 in that length of time, it would be worth talking to a good radiation oncologist for starters. Most doctors would want to see an increase over the span of 3 readings, not 2, before verifying that recurance has taken place.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 1/5/2010 8:08 PM (GMT -6)   
David, thanks for a quick response.  I will try tomorrow to get a recheck with the original lab which as a VA lab.  I am trying not to be an alarmist but realistically know that the 4+5 bears close monitoring eventhough path report gave all negatives except the perineural invasion. The Old Sailor

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/5/2010 8:10 PM (GMT -6)   
With a Gleason 9, I think I would be talking to the radiation guys anyway with anything greater than 0. Adjuvant therapy begun within 4 months is showbn to have much better results.

Goodlife
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


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/5/2010 8:12 PM (GMT -6)   
Old Sailor,
Difference between labs is common (calibration of test equipment and a myriad of other little variables). All my reading leads me to believe that it is fairly important to stay with the same lab, especially with the low levels involved. What you are seeing may simply be testing variation setup with each lab you used............... perhaps causing you unnecessary angst. I would eliminate this possible variable by having another test at your original lab if possible.
Best wishes,
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
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 1/5/2010 9:35 PM (GMT -6)   
These disparities are mentioned here from time to time and, yes, not all labs follow the same testing protocol nor do they all have the same quality of equipment to do the testing and analysis afterwards. My Urologist will not give me statistics further than the 0.0 readings I've gotten for the past 15 months, because he says beyond that the numbers are insignificant. Easy for him to say! But, I do have confidence in my medical team and don't spend any time worrying about it. The suggestion to return to the original laboratory sounds like sound advice to me. Best wishes for a healthier and happier 2010!

Age:  60 (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; 9/09: 0.0

 


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 1/6/2010 7:08 AM (GMT -6)   
Laboratories have inherent drift in their baseline readings. I'm not sure that 0.02 and 0.09 are statistically different results, even if from the same lab. I'm certainly not advising you to not discuss the results with your urologist (that's really important to do IMO), but I don't think it's necessarily a cause for concern.
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, lymph node involvement 0/9, perineural invasion, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: 1 maxipad/day, with minor leakage when I get up from long seated position; ED pretty complete: some erection possible but current non-functional


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 1/6/2010 11:30 AM (GMT -6)   
I appreciate all the info and advice from you folks, thanks again.  I had a retest at the original VA lab today that gave me a 0.020 eight weeks post RPP and it came out at .083 which is not too different from the .090 I received from another lab. Does this mean that the surgery (although a good path report) did not eliminate the Pca and should I probably be looking at SRT if the PSA goes much higher?  I am now 5 months post RPP and as I stated before, know that the Gleason 4+5 is a tricky  devil.   Rich 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/6/2010 11:56 AM (GMT -6)   
Being that you are a confiirmed Gleason 9, if it were me, I would definitely be talking to a good radiation oncologist at this point. They may or may not want to another rise in 2-3 months to confirm if you have a recurrance going on.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/6/2010 4:03 PM (GMT -6)   
Old Sailor,
I think David has given you a sound suggestion. Although still below the generally accepted undectectable level of 0.1, there appears to have been a noticeable increase, albeit at the sensitive level. It is probably a wise move to have a sit down with your doc (and perhaps arrange to see a radiation oncologist and begin researching a possible next step. He may want another reading, perhaps in a month or two, to confirm if anything is actually going on or if this is just another blip with this bloody disease. I think it is generally accepted that if a recurrence does occur the sooner salvage radiation begins the better.
My best wishes,
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
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 208
   Posted 1/6/2010 4:12 PM (GMT -6)   

I talked to the Urologist today concerning the PSA results from the VA Clinic.  She said that even though .09 is close, is still considered undetectable and will schedule a PSA for the next month to see if there is a trend.  If my PSA goes above .4, she said radiation oncologist is the next step. She also said Gleason 8-10 do present special problems, even with "clean" path report.

Again, I do appreciate all the info and help from you folks.   The Old Sailor. 

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