Help with psa reporting

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logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 6/13/2010 3:05 PM (GMT -6)   
I am on a standard assay with clinical labs of Hawaii. My only 2 post/op psa have been 0.0, typed that way on the report. My understanding is that the standard assay lowest detectable level is just less than .1 . Im up on the ultra sensitive stuff, but with good path report, dont want the knowledge, cause I am relatively sure, any recurrence would be systemic and would really need to be conviced by rad onc to do srt. I don't think I would do any HT till psa got to 9 or 10. Im real close to 67 and believe I have that luxury. I know, I say that now..... Don't most std assays report it on paper as undedectable or <.1. Isn't the lab opening them self up for a law suit, when they report on paper as 0.0, when it could be anywhere to .09. MY first could have been .04 and the second could be .08 a 6 mos doubling time. I asked my Uro about this, he really didn't have a good answer, but what he did say was at the various conferences these folks go to, He asked if a doubling time at that low a level was significant. Most hedged, but when He asked if they were involved would they get SRT at that level, most said No. I guess that could be another thread. Is doubling time significant at that low a level. Im aware of the .05 and .1 cutoffs but am also aware of 3 sequential .2's for official BCR. Without diminishing the real heartache of this disease, it really at the same time, is quite fascinating. Please take the last sentence in the positive spirit in which it is stated, Aloha!!
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


142
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Date Joined Jan 2010
Total Posts : 6947
   Posted 6/13/2010 3:13 PM (GMT -6)   
My reports from Bostwick have come back written as "<0.1".

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/13/2010 3:42 PM (GMT -6)   
Short answer: You have a great pathology report...as good as it gets! You made a great choice having surgery! The standard test, with the lower detection limit down to only one decimal place should absolutely be all you need. Time to get on with life!

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 6/13/2010 4:56 PM (GMT -6)   
Hi,

Congratulations on your great PSA test result. A lot of guys here like a lab that gives the result only as <.1, but my own personal preference is a lab that reads the result down to .04. My post op PSA level went slowly up from <.04 and when it reached .08, I made arrangements for SRT. At the start of SRT my PSA level had reached .1. I know that this quite low, but because of the steady rise, I (and the Docs) were certain that is was a recurrence and a low PSA at radiation time gives the best chance at a positive outcome.
Wishing you all the best.

Magaboo
Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
Open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09=0.05; July 09=<0.04; JAN 10=<0.04


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 6/13/2010 5:29 PM (GMT -6)   
Thanks gents, Im feeling real good about it, specially after the last one. Hope I never have to do HT, cause I get pretty emotional with Joy, macho as I be!!!
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/13/2010 6:39 PM (GMT -6)   
logo, from a practical point a <.1, .04 , etc, still means a statistical zero, and means good news. I few, if there is anything touchy in your pathology, then a reading to two decimal places is very useful in case of rapid recurrance, or if the dr. thinks there's a possibility of that. Once a person is out a full year of zeros, then I would feel ok with the one decimal place readings. Seems like doctors have their own interpatation of this subject. You got a good report, that's the most importan part.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/13/2010 7:21 PM (GMT -6)   
Not sure what a statistcal zero is. Maybe sone of you math guys can educate me.

It seems to me it is either a zero or not. Even my ultrasensitive is expressed as <.01, which still may not be a zero.

We hear discussions on here of natural PSA. It is a protien produced by prostate cells. If we have a prostatectomy, we have no more protate cells, theoretically.

Any PSA level be it .01 or 10, must mean we have either left over prostate cells, or cancer cells producing it.

If we say or the experts say that numbers less than a certain level are insignificant, I can sort of buy that, but PSA amounts greater than zero must mean something,m it would seem.
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
1 year psa (364 days) .01


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 6/13/2010 8:44 PM (GMT -6)   
Hi Purgy, thanks for the info, BTW, hope your new job is working out for you, i'm thinking of ya!!!

Goodlife, I hear you, again I talked to my local urologist, on this point, he said, if they ever can go down to the lowest possible point they will find it in a womans blood, so I dont know. You are looking good with ultra.
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


Sharp18
Regular Member


Date Joined Mar 2010
Total Posts : 78
   Posted 6/13/2010 8:57 PM (GMT -6)   
My guess is that any PSA result with "<“ (less than) symbol prior to the number just identifies sensitivity of the measuring equipment. If someone has a different interpretation, please let me know...

Sharp

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/14/2010 6:48 AM (GMT -6)   

 

Purgatory said...
...from a practical point a <.1, .04 , etc, still means a statistical zero...

goodlife said...
Not sure what a statistcal zero is. Maybe sone of you math guys can educate me.

It seems to me it is either a zero or not. Even my ultrasensitive is expressed as <.01, which still may not be a zero...
 

 

Goodlife, and others,

The phrase “statistical zero” has a goofy meaning, at best, and a confusing, misleading, misguided meaning at worst.  I sorta think I know what he means, but I agree…its not helpful using such a term which has no real meaning.

As you are correctly aware, there is no such thing as “zero” PSA in a living, breathing male-with or without a prostate.  The notion of a “zero club” is a misnomer, which causes anxiety in some men when their ultra-sensitive PSA is reported at something other than “zero”, and especially when some (naturally occurring) variation in their test result exists at the ultra-sensitive reporting levels.  Nerve-sparing RP is probably the best known and most significant source of PSA for surgical PC patients with no prostate. 

Goodlife, from your note, thankfully you already know this, but unfortunately not everyone does...which regretfully can cause unnecessary angst, anxiety and worry. 

Hope that this helps further clarify for you and others…

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/14/2010 7:20 AM (GMT -6)   
Casey, I don't think it would be too tough for you to understand what was meant among PC survivors as a "statisical zero". Just because you don't like or understand the loose usage of the word, doesn't mean its invalid. Due to testing standards, normal tolerances within tests, etc, there isn't ever going to be a .00 reading, with or without your prostate in place. So the generally accepted "you are ok" range for a post-surgery PSA reading is anything <.10.
so that would range from .01 through .09, thus becoming the benchmark for a "statisical zero". That's all, you don't need to make it any more or complicated than that. I believe most men here understand that. Stop splitting hairs, it's a general figure of speech.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/14/2010 8:28 AM (GMT -6)   
Purgatory said...
...Just because you don't like or understand the loose usage of the word, doesn't mean its invalid...
 
 
It is entirely invalid...and harmful.
 
What I really don't understand is why one would be so persistent is using misleading words when it clearly causes angst, anxiety and worry time-after-time (every couple of weeks, with our very vulnerable and fragile newcomers) right here on this board in front of everyone's eyes.  That type of behavior is stubbornly and recklessly uncaring...
 
 
 
 
 
 
 
 
 
.

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 6/14/2010 8:41 AM (GMT -6)   
IMO there are enough explanations of the meaning that even the newest of the new soon finds them, I certainly did. Anyone who has had any bio/chem classes is familiar with the meaning of "significant figures" and the limits of testing equipment, other numbers types will recognize "margin of error".

All in all the best we can do is make sure the newcomer is aware of the ACCEPTED TERMINOLOGY and move on. No point in getting upset over terms that almost everyone uses and understands.
Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04
05-03-10 1 week without pads
06-07-10 PSA <0.04


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/14/2010 9:07 AM (GMT -6)   
Casey, you got to be kidding? The term is not misleading, not harmful in the slightest way, once again, you take your opinion and try to force it as fact.

And to say that I am recklessly uncaring? Don't think anyone but yourself would believe that. My posted record speaks for itself here at HW.

It doesn't help new or old friends here, for you to always wanting to be the technocrat and hair-splitter.

I honestly think virtually anyone here would know the term and understand it quickly, and for those that don't use it, they call it something else. You would have to have more important things to think about than this.

To use one of your sayings, time to move 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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Sharp18
Regular Member


Date Joined Mar 2010
Total Posts : 78
   Posted 6/14/2010 10:36 AM (GMT -6)   
David,

Thank you for helping all of us with the basics of PSA reading. I am still struggling with the unanswered question: Does PSA result with "<“ (less than) symbol prior to the PSA number identity sensitivity of the measuring equipment, or it just tells us that PSA does not exceed that number?

For example if it says "<0.06", does it mean that PSA level can be between "0" and "0.06", or it just says that this equipment cannot read PSA below 0.06?

Regards,
Sharp

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 6/14/2010 11:44 AM (GMT -6)   
Sharp...the "<" symbol is just that "less than". All it means is the testing lab could not test below the amount indicated. So in short, yes when you read <0.06 means it can be anywhere from 0.001 to 0.059 And at that level it is considered insignificant and to say the same thing as undetectable at this point. Most folks and the medical community will agree that anything below a 0.10 will be considered undetectable or (zero) if you wish. The medical community in general will define recurrance at 0.20, however if there were three consective increases and at least three months apart from each other, that indicate a possible recurrence (beyond just lab noise) even if still less than 0.20.

The timing to treat post surgery with either adjunctive or in the salvage setting is usually determined by the uro or oncologist and will primarily be based on pre-surgery data about psa velocity and the percentage of cancer and staging. Each surgeon, uro and oncologist has their own protocol for when additional treatment is required. There is no cut and dry rule to apply adjunctive or salvage therapy. As you can see some have treatment early on when a rise in psa is determined...and others much later after a significant change is shown. For what it is worth...generally anything under 0.50 has the same outcome with salvage treatment after surgery.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009     .06
                   6 month Apr 2009     .06
                   9 month Jul  2009     .08
                 12 month Oct 2009     .09 
                 18 month April 2010   .19


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/14/2010 11:51 AM (GMT -6)   
Les,

Thank you for helping to clarify my answer with Sharp. It was a good answer. It is common knowledge here at HW, and we certainly explain it often to our new friends, that when we talk about the "zero club", its not literally a .00. It's undetectable based on the standards of the particular test.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 6/14/2010 1:31 PM (GMT -6)   
Logo,  I hope you don't mind if I ask another PSA question on your thread.  Several years ago,  investigators from Mayo Clinic  evaluated the performance of 17 different commercial PSA assays and their accuracy at low PSA levels.  I have not been able to find the results of the study  and wondered if anyone might know the link.  Like you, I am always curious and just trying to learn more.
 
Thanks,  Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, stg. pT2c, N0, MX, R0, Gleason 5+3=8 
PSA <0.1 at 20 months and each test since surgery.


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 6/14/2010 1:34 PM (GMT -6)   
But of course, mi thread, su thread lol
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/14/2010 2:02 PM (GMT -6)   
that would be interesting to see, carlos
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/14/2010 3:08 PM (GMT -6)   
Carlos,

Medved has a lot of data on this. His data also showed wide variances between techniques.
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
1 year psa (364 days) .01


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/14/2010 4:13 PM (GMT -6)   
With one exception, all of my PSA tests have been ran at the same lab since 2002, and the one that wasn't done by them, instead by my local hospital - is the one that got goofed up, lol. I like consistency in the testing.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


ruggles
Regular Member


Date Joined Jan 2010
Total Posts : 26
   Posted 6/14/2010 4:33 PM (GMT -6)   
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:
http://webdoc.nyumc.org/nyumc/files/urology/attachments/shen_lepor_taneja.pdf
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
12/09 FreePSA 10%
Biopsy 12/09 3/12 cores positive for 3+3  (10%, 20%, 20%)
Multi-focal Adenocarcinoma 4th core Hi PIN (bonus!)
DREs negative
daVinci  2/9/10 only in Hospital for 25 hrs
Cath out 2/16/10
Path report:
Gleason still 3+3
Benign Margins
Benign Seminal Vesicles
No Extra-Prostatic Ext
No Vascular Invasion
Adenocarcinoma < 5% of Prostate
99.5 % dry at 6 weeks
pills and pump regular but ED still an issue
Post op PSA
3/19/10    0.01
4/21/10   <0.01


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/14/2010 5:19 PM (GMT -6)   
Ruggles,

You and I are in agreement. While having a PSA that is below .1 or .2 may mean that you don't have a full blown reoccurence, it just stands to reason that movements of any amount are indiciative that there is something producing PSA. It appears that rate of growth is an important indicator in the PC prognosis business.

In my own case, with a Gleason 9, I am watching everything extremely carefully for any indication that the PC is growing. When I think I can make that determination, I am moving ahead with radiation. For me a movement from .01 to .05 is enough to set off my alarms.

I understand that doctors don't like to have to respond to nuts like me and a small rise in PSA. They would never get any work done. On the other hand, I am somewhat sensitive to generalizations about what is zero, or what is "statiscally zero", etc. I don't mean to sound critical of anyone, it is just my own paranoia about this topic. I certainly am not depending on my doctor to tell me its time.
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
1 year psa (364 days) .01

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