Interesting Q&A on ultrasensitive testing

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BillyMac
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Date Joined Feb 2008
Total Posts : 1858
   Posted 2/7/2010 9:02 PM (GMT -6)   
Although the discussion dates from 2003 it is still quite valid.
 
Bill

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/7/2010 9:34 PM (GMT -6)   
Still good info there, Billy. Thanks for posting it.

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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 2/7/2010 9:54 PM (GMT -6)   

Interestingly, Dr. Menon's team advises AGAINST using the super-sensitive PSA tests. They cause to much grief.

I know Dr. Strum advocates using it.

Dr. Menon's team does NOT advocate that I have adjuvant radiation. Dr. Epstein at Hopkins does indicate that it should be strongly considered.
 
Obviously, there are plenty of grey areas in this disease.
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10


goodlife
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Date Joined May 2009
Total Posts : 2691
   Posted 2/7/2010 10:00 PM (GMT -6)   

Bill,

I recently had my 9 month post op PSA.  Because of insurance I changed labs.  When I went to medical records and got my results ( I am an A type personality and hate to wait). I noticed it was less than .1.  I didn't like the sensitivity so I asked the lab and they said it must say ultrasensitive on the script.

So I called URO and had them send a new script.  The new result was less than .01.  The boilerplate on the results said that less than .05 was considered the reference level of in those with radical prostatectomies.

As a G9'r, I intend to monitor this ultrasensitive testing closely.  Once mine hits .05 or .06, I am going in for SRT.  I really believe the stated .5 is way too high.

 

 


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 injection
No pads, 1/1/10,  9 month PSA < .01


Worried Guy
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Date Joined Jul 2009
Total Posts : 3732
   Posted 2/8/2010 6:50 AM (GMT -6)   
The numbers quoted in the Q&A are for very low limits: See the quote attached at the bottom of my post. (All numbers are ng/ml)
They are looking at values less than 0.01 with a variation of .002.

As long as we understand that the machine variation is 20% for values less than 0.01 we shouldn't get heartburn if we see a number go from 0.010 to 0.012.
But using a machine with a useful detection limit of 0.1 (and presumably with the a 20% CV) IMO is not sufficient to detect a true rise until quite late in the game. Imagine you have a PSA drawn every 6 months and your true PSA begins to rise from 0.02 to 0.06 to 0.09 to 0.12. The single digit report would say "<0.1 " for all of them (2 years) at 0.14 and 0.16 the report would finally say " 0.1" . ( 3 years) At that point , your Uro might even say "Well that is the resolution of the machine so no worries. See you in another 6 months! Finally you hit 0.18 and maybe the report finally says 0.2. Do you trust that one or take another? You would have missed starting treatment early by 1 to 2 or even 3 years.
Back in 1995, 0.1 resolution was the norm. Equipment could not get down to lower levels at reasonable cost. Machines and detection limits have improved tremendously (30-100x) since then and so has our knowledge of early treatments.
The 0.1 resolution is fine if you have a prostate. But after RRP and other treatments, you need the extra digit.
Make sure the diagnostic box is checked and don't get excited if the variation is less than 0.02.

If you are going to demand have an accurate test and want consistent, comparable results, it is your obligation to be consistent too. Go to the same lab every time. Take the test at the same time of the day, eat or not eat in the morning but be consistent. Be consistent with your sexual activity, and medications.
In my case, I take the test in the morning, nothing to eat after midnight, no sexual activity for 2 days before. Does it make a difference? I really don't know - I have not done the experiment. But, I do know that I want that extra digit to count, so I do everything in my power to help. It is the burden I accept for insisting that the on "Diagnostic" box is checked on my lab request sheet.

Jeff (0.05 - and watching it like a hawk)


From the Q&A above:
"So-called 3rd generation PSA assays must have clinically useful detection limits <0.01 ng/ml. Analytical sensitivity needs to be < 0.005 ng/ml and functional sensitivity (20% cv) <0.01 ng/ml. An assay control with target concentration near this concentration is required and should be monitored each shift the analyzer is run. We observe between assay cvs of <10% over many months. Stable control materials are available from several manufacturers. It may also be useful to use aliquots of serum obtained after prostatectomy but gradual loss of immunoreactivity from deep frozen samples has been observed. We have not observed significant lot to lot variation in the estimate of these low concentrations but reagent lot changes, particularly of substrate, should be examined closely. The DPC Immulite assay is essentially equimolar in its detection of PSA isoforms. We observe differing baseline estimates of “PSA” in men post prostatectomy, varying from near 0.001 to near 0.01.


"The DPC Immulite sensitive assay, which has an analytical detection limit of about 0.002 ng/ml, functional sensitivity (20% cv) of about 0.005 ng/ml and clinically useful sensitivity of about 0.01 ng/ml."
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots, See Uro 1/22/10 Trimix unsuccessful.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.

Post Edited (Worried Guy) : 2/8/2010 5:54:15 AM (GMT-7)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/8/2010 12:21 PM (GMT -6)   
hey jeff,

Does playing with dead weapon count as sexual activity ?
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 injection
No pads, 1/1/10,  9 month PSA < .01


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/8/2010 12:41 PM (GMT -6)   
Good:
 
Maybe assault with a non-deadly weapon?
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 2/8/2010 6:51 PM (GMT -6)   
BillyMac,  Thanks for posting the link.  I find the question/answer about the possiblity of being "cured" if ones PSA remained at the 0.02 level for a couple of years very interesting.  It has piqued my interest in the ultrasensitive test, but I'm still not sure I want to know anymore.  I also found an interesting article on the Yana now site,  www.yananow.net/UltraPSA.htm , that discussed the test.  The writer of that article was a little less enthusiastic about the test. 
 
Worried Guy. Jeff,  please help me with a little math.  The ultrasensitive numbers in the articles are talking about measuring PSA down to one trillionth of a gram.  I tried to put this into perspective but had too much trouble with all of the zeros.  The best real life comparison I could come up with is that the test is detecting something on the order of a gnat's ass in a 30,000 gallon swimming pool.  That is pretty impressive.
 
Carlos


Diagnosed 2/2008 at age 71, PSA 9.1, Gleason 8 (5+3)and stage T1c. 
Robotic surgery 5/2008, nerves spared, All margins, SV and lymph nodes were neg. 
Staged pT2c, Gleason sum 8 (5+3).
Continent at 6 weeks. 
PSA <0.1 at 20 months, Jan. 4. 2010.

Post Edited (Carlos) : 2/9/2010 7:09:45 AM (GMT-7)


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 2/8/2010 8:15 PM (GMT -6)   
I think that one ng/mL works out to roughly one gram per swimming pool...seriously.
 
A US dollar bill weighs one gram.

Post Edited (Casey59) : 2/8/2010 7:21:09 PM (GMT-7)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/9/2010 7:39 AM (GMT -6)   
Casey,
You got me thinking - and that is very dangerous. I agree with your number For a 10 meter x 5 meter x2 meter pool that is 1 gram. (10e11)

A typical protein has a molecular weight of 50, 000 to 350,000 Let's call it 100,000 for easy math. www.springerprotocols.com/Full/doi/10.1007/s12575-009-9008-x?encCode=T0lCOngtODAwOS05MDAtNTc1MjFz&tokenString=7pl4lUV8YUDZ6S4R31pyFg==

So using Avogadro's number, there 6.022 x 10e23 molecules in 10e5 grams of PSA. So 0.01 ng (1e-11) contains 6.022 x 10e23 * 10e-11 /10e5 = 6.028 x10e7
Unless my math is wrong there are still 60 million PSA molecules in that 0.01 ng/ml mix.

We accept that CSI can grab DNA from the edge of a cup that someone drink from. We can extract proteins and chemical traces from the fingerprint left by a perp and in some cases even detect race and general health info from the electrolytes remaining. Maury Povich, daily, will declare that Jamal is, in fact, "the baby daddy" based upon a hair sample. However, in a surprise twist, Uneequa was not the mother.

We have detectors that count single photons - and they weigh a lot less than a molecule.

My GPS works by comparing the time difference of radio waves moving at the speed of light from three satellites orbiting the earth at 17,000 mph 1000 miles away. We read must read those signals to better than 1 nanosecond resolution for 3 foot accuracy. My GPS cost $200

So, in 2010 it is not unreasonable to expect PSA accuracies to 0.001 ng/ml. Whether it is worth the cost is a different matter. For a screening PSA, 0.1 resolution is fine. But post treatment, 0.01 should be required since it makes a difference in treatment options .

Twenty years from now we will have PSA readings down to 0.001ng/ml equiv. from a simple clip-on finger scanner. We can bet on it.

Jeff

Goodlife- After I first looked at a target through my new Leupold I had to change my underwear - and that was before I was incontinent.

Post Edited (Worried Guy) : 2/9/2010 9:29:37 AM (GMT-7)


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 2/9/2010 8:42 AM (GMT -6)   

Thanks for that additional analysis, Jeff.  Science rocks!!  As nerdy as it sounds, I think this stuff is pretty interesting.

Anyhow, you've piqued my curiosity regarding your comment "So, in 2010 it not unreasonable to expect PSA accuracies to 0.001 ng/ml. Whether it is worth the cost is a different matter."

My insurance pays about $175 for the standard PSA test (lower detection limit of 0.1 ng/mL).

This question is for you guys who have had the ultra-sensitive PSA test:  What is the cost of one ultra-sensitive PSA test?

regards


compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 2/9/2010 10:40 AM (GMT -6)   

Casey:

 

If I told you, I'd have to kill you, because that is a SENSITIVE issue.

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/9/2010 10:42 AM (GMT -6)   
I have clearance...and have the scars to show it

Worried Guy
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Date Joined Jul 2009
Total Posts : 3732
   Posted 2/9/2010 11:02 AM (GMT -6)   
Casey,
I spent more than few minutes looking around to find the price of a test. I can tell you how many molecules are in the blood but I can't say how much the tests cost. I can't find it. (This one of the problems with our health care system. Free market info is not readily available. ) Maybe someone in another country will know.

As an engineer I'd say the bulk if of the costs are in the collection of the samples, the tracking and control of samples, the reporting to the doc and the finally reporting to the patient. As far as the machine in concerned, the calibrations procedures are similar. The testing control reagents are probably a little more expensive since they need to be one additional decimal higher in purity. If I look at the Alfa Aesar catalog I see that the extra decimal point in purity is worth anywhere from 10% more to triple the base price of my small sampling of reagents.

From what I can see the biggest reason for not reporting the extra decimal place is not higher costs or "patient angst". It is not having the machine in your medical group.

If the only tool in your toolbox is a hammer, the whole world looks like a nail. If a lab has a 0.1 unit that works fine, they will manage to justify the one decimal place as sufficient.

Jeff

Notice that the bill you receive is carried out to the penny. The next time you have to pay it, try dropping a few of the least significant digits and see what happens. "Oh! $100 isn't the same as $122.59?"

Post Edited (Worried Guy) : 2/9/2010 12:42:10 PM (GMT-7)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/9/2010 11:19 AM (GMT -6)   
My wonderful wife called the University of Rochester Medical Center lab and asked for the charges.

$85 for a screening PSA (1 decimal) and
$111 for a diagnostic PSA (2 decimals)

Plus $11 for the drawing the blood.

One caveat: The person my wife spoke to said the $111 was for screening and $85 for diagnostic. Diagnostic was cheaper! That did not make sense to me, maybe she read it wrong, so I reversed the numbers above. Either way, they are very close.

I made my contribution for today. Can someone else check their favorite lab?

Jeff

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 2/9/2010 11:51 AM (GMT -6)   
Jeff,   Thanks for posting the cost info.  I had been under the impression that the higher sensitivity test was much more expensive.  My uro only offers the screening test because as you pointed out that is what his group has.  I use another lab when I get PSA anxiety and don't want to wait for my next appointment.   My uninsured charge is a total of $35.00 for the screening test.  This includes collection, overnight air from P'cola to the Tampa Quest lab and the email with the results the next morning.  
 
They will also run the diagnostic test but the person who knows how much it costs is out of the office today.  Will let you know tomorrow.
 
Carlos

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/9/2010 12:07 PM (GMT -6)   

Carlos:

Does QUEST lab do the ultrasensitive test?

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/9/2010 12:28 PM (GMT -6)   
Mel,

I was just poking around the Quest site when I came back here and saw your question posted to Carlos.

Quest does do ultra-sensitive PSA. They call it "Post-prostatectomy PSA". Described here: http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=14808.html&labCode=WDL

regards

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/9/2010 2:02 PM (GMT -6)   
Carlos,
Thanks for the numbers. It seems that there is quite bit of variation between locations. Let us know when you get prices for the Post Protatectomy PSA. Given that the standard PSA is $ 35, I'd be surprised if it is more than $70.

Casey,
What a great find! That is the kind of data I like to see. Does this mean that anyone can walk in off the street and get a PSA test done without a doc ordering it? It does gall me to have to go to the Uro's office to get the darn number. I know what the numbers mean. Ok maybe the first or second time but after that, you are a big boy. You can figure it out. Why do you have to make an appointment, go to the office , pay a copay, to have the PA say: "Your PSA is 0.xx. See you in three months. Oh, Bend over... Nope, no prostate in here." ?

Hey Europeans and Aussies !
What are costs for single decimal and two decimal PSA tests in your neck of the woods?

Jeff

Post Edited (Worried Guy) : 2/9/2010 1:05:39 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/9/2010 2:10 PM (GMT -6)   
My first post-SRT PSA test was done at my local hospital's lab, because of all the backing up of labs at Christmas. They charged $175 for drawing the blood, sending it off, and getting the writen results. My insurance picked it up 100%, and then Aflac gave me $75 back for having it done. Not a bad deal for me.

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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/9/2010 2:23 PM (GMT -6)   
David:
 
All together now:  QUACK QUACK AFLAC; QUACK QUACK AFLAC!
 
JEFF: Do you have to make an appointment each time to get your PSA results? That's ridiculous. I just call and they tell me. I can even drop by the office and get a hard copy of any test results, free. Heck, they charge enough for my regular office calls!
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10


BillyMac
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Date Joined Feb 2008
Total Posts : 1858
   Posted 2/9/2010 3:06 PM (GMT -6)   
In Australia there is no direct charge to the patient for a PSA test of either kind. Almost all blood tests are fully covered by our universal health scheme (funded via the tax system). It is a basic cover for all which appears somewhat similar to your medicare coverage for the retired)
The actual charge to the scheme by the pathology labs for the test in 2008 appears to be about Au$20-00

www.cs.nsw.gov.au/csls/handbook/Results4.asp?Test_id=5941&fromESS=1

It is interesting that the guidelines for testing within that site caution against collecting the blood sample following a DRE. Take note doctor!!!

There is a little more reading here on the pluses of using the ultrasensitive test.

www.prostate-cancer.org/education/preclin/McDermed_Using_PSA_Intelligently2.html

Bill

CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 2/9/2010 11:08 PM (GMT -6)   
An interesting comment for us "low risk" guys:
 
"Of particular significance, however, is the ability sensitive PSA measurements have to identify patients who are certainly not destined to have recurrent cancer. Such men are identified by PSA <0.01 ng/ml and no or minimal increases during the 2 years post prostatectomy."
 
The "0.01" is referring to the value after surgery, with the necessary waiting time for PSA decay. I have posted on this before, and I am curious as to why the LOWEST level for post-prostatectomy PSA is always the one after surgery. Of course, some guys unfortunately get a recurrence and their PSA trends up. For the guys that do not experience a clinical recurrence, their PSA trend can either be a) constant and low, b) fluctuating but low, c) minor increase, but stable below 0.1 or possibly 0.2. What I have NEVER seen is a trend DOWN from the PSA level after surgery. What makes the post-surgery level apparently the absolute lowest level that a man can expect during recovery?
 
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
10/19/09 PSA: < 0.1 (switched to "standard" assay)
 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/9/2010 11:43 PM (GMT -6)   

I'm not sure that's true.

 

I thought some folks here had xxx as their first post-surgery PSA and then it was a tad lower after that. Maybe I'm wrong. Anyone??

 

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/9/2010 11:52 PM (GMT -6)   

I think MichGuy is a counterexample to your theory

 

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry but using 1 pad at night for security.

Next Event: First post-op PSA on 3/1/10

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