This subject has been a hot button for me since deciding on surgery, and I was consumed with reading about what to expect and what might follow from various readings.
This report was particularly relevant, summarizing succinctly what other readings implied:
If you have no prostate and no cancer then your PSA should be close to zero, though zero is not possible to reach. The recent conferences had published reports of new tests that could measure PSA with 4 zeros after the decimal point and perhaps these tests will spur studies of realistic values and ranges to become published and refine the "common knowledge" in the future.
I get sent to Quest labs which has the "Post-Prostatectomy" PSA test (Analytical sensitivity: 0.01 ng/mL) and has to be sent 500 miles south, so clearly not used as often. The regular test is processed in town. It costs a little more but still under $100 before the insurance. I have to insist my urologist write the slip for this test every visit because he thinks "nobody uses it". I wonder if ignorance is bliss.
I got the impression a "standard assay" test would be reported as <0.1, 0.1, 0.2, 0.3, 0.4 etc.
With a test that is only accurate to tenths of a point a 0.1 might include the range 0.06 to 0.14 .
If 0.20 is a recurrence, the standard assay test for me was in a class with "drive by appraisals" or "the fish was longer than my arm".
After removal of the prostate the PSA level is going to drop, and it seems very significant, when and how far it drops, what the low point (nadir) is and if it goes up, when and how fast it rises.
One can not really know this, or pass this info to an oncologist who might ask, if there are not ultrasensitive samples taken at regular and frequent intervals. In a lot of cases it's not necessary to even wait the 3 months, after surgery, to see the PSA burn off and reach the low point, such that conceivably, it may have started back up again by the third or fourth month and if you were not tested you missed your low point.
Also of interest is the statement near the end of page 3: "...PSA nadir was achieved at a mean followup of 10.4 months."
Determining the patterns on nadirs, and times to recurrence, and local vs. systemic recurrence seem to be tied to trending info on PSA levels.
Might as well take a close look if you're gonna look at all! What you do with the info is entirely up to you but it gives you more time to work out the plan for the next step!
Age 59 PSA: 8/09 - 5.7
, 10/09 - 6.4
, 12/09- 7.2
, 2/10 - 7.4