Funny Thing Happened at the Blood Lab...

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TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 9/16/2010 6:04 PM (GMT -6)   
Stopped by the lab after work and handed the phlebotomist my script from the doctor. As she's studying it with a puzzled look on her face, I told her that my doctor wanted the post prostatectomy PSA test, not the standard PSA test. She said yes, but the code for the standard PSA test is what is on the script. Then I pointed out to her that in the comments section at the bottom of the form, they had typed in "post prostatectomy PSA" because they did not know, nor could they find, the proper code. So, I'm getting my blood drawn, trying to think about other things but I noticed it was taking longer than normal. She finally finishes and much to my surprise, she is holding two vials. I asked why she took two vials and her reply was that the way the doctors office wrote the script indicates that the doctor wanted both tests, standard and post prostatectomy PSA. I don't know if they use different assay methods for the two tests, but it will sure be interesting to see if the two results are in agreement.
Dx: in 6/2005 age 49, PSA 4.1, 2/10 cores pos, G6, T1c
bone scan: negative
daVinci RRP 8/2005, Hartford Hospital, Dr. Wagner
Upgrade G7 (3+4), pT2c, NX,MX, neg. margins, perineural invasion present, tumor invades capsule but not through it.
PSA <0.1 until 4th yr post surgery, then 7/2009 0.1, 10/2009 0.2, 1/2010 0.2, 2/2010 0.14, 4/2010 0.16,
8/2010 0.25 (oh darn it!).

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 9/16/2010 6:26 PM (GMT -6)   
Talk about padding the bill...Zero is zero either way...The standard PSA test can read down to 0.1 and that's good enough. Taking it out another decimal place to 0.01 can cause more trouble than it's worth...The "ultra-sensitive" test is considerably more expensive at most labs..Your insurance may balk at paying for two tests..
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP performed Sept 3 2010

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 9/16/2010 6:26 PM (GMT -6)   
I thought the same thing when the doc could have checked off the regular PSA and free PSA test - how the numbers would vary from pre-op results - keep us informed on what happens.

BRONSON

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/16/2010 6:39 PM (GMT -6)   
Hey Taurus.
about 4 months ago we checked the prices of screening PSA (one decimal ) and the Diagnositic PSA (2 decimal) and found the prices to be virtually identical. In fact, in one area the 2 decimal test was LESS!

I am part of a study comparing two different assay methods for the diagnostic PSA test - the 2006 protocols vs the new 2010 protocols. You might be in a study, too. That's how diagnostic tools improve. 20 years ago they were reading PSA to NO decimal places and 200 years ago they read it by counting the number of fat leaches.
That's progress. 10 years from now we will be getting results to 3 decimals.

My signature has my numbers and protocol comparisons. The latest and greatest is ECLIA.
See if you can get your hands on the reports.

Good luck. May you have <0.02 That's no bull.
Jeff

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 9/16/2010 6:50 PM (GMT -6)   
Worried Guy said...
Hey Taurus.
about 4 months ago we checked the prices of screening PSA (one decimal ) and the Diagnositic PSA (2 decimal) and found the prices to be virtually identical. In fact, in one area the 2 decimal test was LESS!

I am part of a study comparing two different assay methods for the diagnostic PSA test - the 2006 protocols vs the new 2010 protocols. You might be in a study, too. That's how diagnostic tools improve. 20 years ago they were reading PSA to NO decimal places and 200 years ago they read it by counting the number of fat leaches.
That's progress. 10 years from now we will be getting results to 3 decimals.

My signature has my numbers and protocol comparisons. The latest and greatest is ECLIA.
See if you can get your hands on the reports.

Good luck. May you have <0.02 That's no bull.
Jeff


Hey Jeff,
results are already reported to 3 decimals. The ultrasensitive test in fact delivers a result to 3 decimal places (down to its detectable limit of 0.003ng/mL) but as the result is somewhat variable at this level it is usually reported as <0.01

www.phoenix5.org/Basics/PSAundetectable.html

(a) Standard test -----------1 decimal place
(b) Hypersensitve test------2 decimal places
(c) Ultrasensitive test-------3 decimal places

Post Edited (BillyMac) : 9/16/2010 6:57:20 PM (GMT-6)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/16/2010 7:30 PM (GMT -6)   
BillyMac

Exactly. I know there are couple of guys here (you included) who get results to 3 decimals.
My point is that in 10 years, everyone will have it. The advancing technology will offer it and the stakeholders will demand it.
Hey, did you tell me the cost for your testing? $85 plus $15 for the phlebotomy? I can't recall if that was you.

Jeff (a data point on the road to improved PSA testing)

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 9/16/2010 9:18 PM (GMT -6)   
Jeff,
I am located in Sydney where the cost is fully covered under our universal health scheme. The cost here that is charged for the test (no matter the sensitivity a few years ago was $20-00. I believe it has risen about 10-15% since then.

www.sswahs.nsw.gov.au/sswps/default_hb.htm

Bill

Post Edited (BillyMac) : 9/16/2010 9:21:36 PM (GMT-6)


TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 9/24/2010 5:21 PM (GMT -6)   
Update on the double PSA test I had on 9/16. The standard test result was 0.2 and the two-decimal place result was 0.23.
Dx: in 6/2005 age 49, PSA 4.1, 2/10 cores pos, G6, T1c
bone scan: negative
daVinci RRP 8/2005, Hartford Hospital, Dr. Wagner
Upgrade G7 (3+4), pT2c, NX,MX, neg. margins, perineural invasion present, tumor invades capsule but not through it.
PSA <0.1 until 4th yr post surgery, then 7/2009 0.1, 10/2009 0.2, 1/2010 0.2, 2/2010 0.14, 4/2010 0.16,
8/2010 0.25 (oh darn it!).

pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 437
   Posted 9/25/2010 12:41 AM (GMT -6)   
I am glad I always had post-op PSA tests with two decimal places... In my opinion, it allowed me to see a pattern and jump on SRT at the most opportune time for success based on my post-op pathology.

With single decimal PSA, it would be mathematically possible to have an actual rise in PSA going from 0.06, 0.08, 0.10, 0.12, 0.14 all reported as 0.1 in a single decimal test
 
In my opinion, you would have lost some valuable information about a potential BCR and the most timely, effective, and appropiate treatment strategy for it.

PCa is a true beast and I will always look for the best and most reasonable testing methods to keep my eye on it...

Best to all, pasayten
3/2007 - Dx 59 y/o - 12 point biopsy - Left 0/6 Right 1/6 Gleason 3+3 T1c
4/2007 - DaVinci RRP performed - Gleason 6 T2c Nx Mx
PSA 7/07 0.01, 6/08 0.02, 12/08 0.03, 10/09 0.13
11/09 Consult BCR and recommendation for SRT
1/2010 IMRT SRT started 32 sessions at 2 gys for 64 gys total.
6/2010 3 mth PSA post SRT = 0.02 :-)
My Extended Signature

Post Edited (pasayten) : 9/25/2010 12:46:45 AM (GMT-6)

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