May be out of the Zero Club

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Date Joined Jan 2010
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   Posted 10/22/2010 2:37 PM (GMT -6)   
Using my Uro's logic of no ultra sensitive PSA, I'm still <0.1.
I had my GP run one yesterday. Complication - they changed labs since the <0.01 I got in July.
Result was 0.02. Not <, just a flat 0.02.
Worst read, a rise with a doubling time of 3 months.
Best read, I'm still <0.1.
Have calls in for the uro, and am looking up medical oncologists, since my options are pretty limited now. (DaVinci 10/2009; IGRT spring of 2010).

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Date Joined Jun 2010
Total Posts : 416
   Posted 10/22/2010 3:09 PM (GMT -6)   
142. Sorry you gotta deal with this crap at all.

Do we know if they even give the "<" other than in relation to "1"?

Anotherwords, they use <0.01 and <0.1 to suggest that it is "less" than "something"..
depending on standard or ultra test. But they can call "less that 3" soemthing - It's 2.

Perhaps they dont even use the "<" for any other number.
(If it's common with other readings and I missed it, sorry).

And I dont know if your being fair to yourself by looking at a "doubling time" using .01 and .02... I mean ANY increase in .01 has to naturally go to .02. That you be different from going from .1 to .3 or something. I hope.

I hope you (and I) are just proving those docs who dont like the ultra, dont like them for a good reason.

All the best.. i'll be thinking good thoughts for you.

Bob F.

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   Posted 10/22/2010 3:27 PM (GMT -6)   
Just that level PSA is NOT cancer specific even after surgery and IGRT. There are still "other" things that still produce PSA. Even females have that small amount of psa in their blood stream.

Wait another 3 months and test again. Otherwise don't sweat the small stuff right now.
You are beating back cancer, so hold your head up with dignity


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   Posted 10/22/2010 3:29 PM (GMT -6)   
The < should indicate the lowest measurement the test can register. So, if the new lab had a test that did not make it to the expected <0.01, I would expect to see <0.03, for example, meaning that they can not read below that number.
So the lack of a < means, in my interpretation, that their test would have seen less if it had been there.
And yes, it might be "noise" in the test. It is a different lab, could be different equipment. But going back to the uro (I do have another followup in a couple of months), I will be at the  same lab as the previous visit to him, but only to 0.1 precision. So we are back to the old problem of how long do you wait.
I may head up to to lab where they did the July test and get another one there just to minimize variance.
Never had PSA anxiety until now - a year out. Sort of like jumping off the edge.

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Date Joined Sep 2010
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   Posted 10/22/2010 3:34 PM (GMT -6)   
I've been reading comments like these, and I have to admit I still don't understand the Ultra tests. It takes 10 ".01's" to get to "1." So, a person could be .09 and still be <0.1.

Why then all the worry and concern about going from .01 to .02? That's still a whole lot less than 0.1, and is it really significant to any degree? Even going to 0.8 would still be <.1

And even though it's true that mathematically .02 is twice .01, does it really represent a "doubling" of the volume of cancer (assuming there actually is cancer present somewhere at these low numbers).

Maybe someone can explain this in layman's terms.
Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays all negative.
DaVinci surgery late August at Advocate Condell, Libertyville IL
Negative margins; negative seminal vesicles
Smooth recovery; 18 holes of golf at 4 weeks.
Continence OK after 7 weeks. ED continues

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Date Joined Nov 2009
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   Posted 10/22/2010 3:34 PM (GMT -6)   






PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

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   Posted 10/22/2010 3:36 PM (GMT -6)   
Yeah, I agree on the premise. I was happy with 1 decimal precision until I learned about 2. Sometimes too much information really is too much.
But being an engineer of sorts, and not having an optimistic bone in my body  (I was told by a pilot friend that I can't fly - I'd never get past the details on the checklist to take off), I have to add a new mind-set to the new normal PCa brings.
Off on another three-month pass, I guess.

Cajun Jeff
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Date Joined Mar 2009
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   Posted 10/22/2010 3:37 PM (GMT -6)   
142 will be waiting to hear what you find out. Keeping my fingers crossed for you my friend.

Cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
Only issue at this time is ED

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Date Joined Jul 2008
Total Posts : 966
   Posted 10/22/2010 3:49 PM (GMT -6) made me laugh at your comment.. But I fully understand...I have a brother the same way...being of the analytical mindset.

You the engineer and Mel the mathmatician will always look at those small numbers and calculate/assess what it means. The rest of us just ponder.

Good luck my friend.
You are beating back cancer, so hold your head up with dignity


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Date Joined Jul 2010
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   Posted 10/22/2010 4:17 PM (GMT -6)   
PSA anxiety out the WaaZoo...Maybe you should back away a little bit and let a definite trend develop before you push the panic button...These tests are so sensitive, the difference between 0.01 and 0.02 can just be a little background noise...

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Date Joined Mar 2009
Total Posts : 739
   Posted 10/22/2010 5:12 PM (GMT -6)   
Fairwinds, nailed it....................Kev
Age 52yrs [Gold Coast Qld, Australia]
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
RP 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - EPE
Dry less than 1 week. ED- okay with Meds.
PSA at 18mths no change remains 0.03
"Everday in Everyway, I get better"

English Alf
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Date Joined Oct 2009
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   Posted 10/23/2010 4:56 AM (GMT -6)   
I refer to a post I made a while back about this kind of thing where it seems that this is a massive jump. If you could tell what your PSA was every day you'd be able to spot trends and fluctuation much more easily. The problem is not just the one number is bigger than another number it is the waiting "game" till you get to hear the next number.
The way decimals are rounded off a rise from 0.01 to 0.02 could actually only a rise from 0.014 to 0.016! It could be at 0.017 tomorrow, 0.013 and then 0.016 again and so on and really only fluctuating around 0.015, which in my book is still zero club.

There is an element of relativity here about numbers.
Your PSA doubling might be 0.01 to 0.02 or 0.1 to 0.2 or from 0.2 to 0.4 and I'd say it's only when you're dealing with the bigger numbers that you might need to have a bit more of a careful think about what is going on.

It's like hearing that unemployment figures in some town have gone up by 300%, when they actually rose from 1 to 4 due to the gas station closing in a town with a population of 200. A 50% rise might thus seem like a better situation, but not if it's a rise of 50% from 5,000 to 7,500 in a town with a population of 75,000!


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Date Joined Jul 2010
Total Posts : 161
   Posted 10/23/2010 8:00 AM (GMT -6)   

Researchers at Wake Forest University School of Medicine and the University of Wisconsin-Madison have discovered that some elevated prostate-specific antigen (PSA) levels in men may be caused by a hormone normally occurring in the body, and are not necessarily a predictor of the need for a prostate biopsy.

Elevated levels of PSA have traditionally been seen as a potential sign of prostate cancer, leading to the widespread use of PSA testing. However, the researchers found that parathyroid hormone, a substance the body produces to regulate calcium in the blood, can elevate prostate-specific antigen (PSA) levels in healthy men who do not have prostate cancer. These "non-cancer" elevations in PSA could cause many men to be biopsied unnecessarily, which often leads to unnecessary treatment

I read this when investigating the need for biopsy [for my husband]. I wonder if it has any significance in psa readings after surgery??????   Cooper

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Date Joined Jan 2010
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   Posted 10/23/2010 8:26 AM (GMT -6)   
Yet another good point about PSA existing after Prostate removal.
I think that my biggest mental issue with all this is that for a year I've done the good patient role, been cut, nuked, and poked. Then at exactly one year out, "undetectable" drops out of the conversation.
Everyone has very good points about the degree of detectable, and I will follow my own advice to take another 3 month pass, but I will be updating my local oncologist list regardless.
Maybe that will qualify me for flight lessons? smilewinkgrin

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   Posted 10/26/2010 10:30 PM (GMT -6)   
News -
I got the lab copy of the results. The report was 0.02, but when you look up the equipment they (the new lab) used on the manufacturer site, the minimum reliable report is <0.04. So I am less than the normal reportable range.
My GP has agreed to a prescription for a retest at a lab I specify so I can compare against the previous lab results (<0.01, equipment unknown), which I will do next month.
So I'll ask to keep my zero club seat for now, if I may.

Veteran Member

Date Joined Aug 2009
Total Posts : 652
   Posted 10/26/2010 11:05 PM (GMT -6)   
142, in my book, you are comfortably inside the zero club. I've told myself that if/when I get there, anything 0.03 or below will be a complete zero to me, moving upward or downward.
I say, enjoy.
Gleason,3+4;PSA,7.9,Nerve-sparing RRP,03/2008(Age 48 then),confirmed 3+4 Gleason,pT2c, 60g, neg margins; perineural & lymphatic invasion present;3 lymph nodes removed,clear seminal vesicle invasion:absent;Gleason 4 was 5-10%; PSA <0.1 until Oct 09:0.1; retest <0.1; scans clear;monthly results from Jan 2010:0.2,0.2,0.17,0.17,0.24,0.31,0.29,0.41, IGRT SRT started 8/4/2010, PSA@5 weeks into SRT:0.17

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Date Joined Feb 2008
Total Posts : 1858
   Posted 10/27/2010 12:05 AM (GMT -6)   
142 said...
News -

I got the lab copy of the results. The report was 0.02, but when you look up the equipment they (the new lab) used on the manufacturer site, the minimum reliable report is <0.04. So I am less than the normal reportable range.

My GP has agreed to a prescription for a retest at a lab I specify so I can compare against the previous lab results (<0.01, equipment unknown), which I will do next month.

So I'll ask to keep my zero club seat for now, if I may.

That is what is so frustrating about these labs. Here's a lab with equipment that can detect PSA down to a level of 0.04ng/mL. Anything below this level registers "not-detected". So how does a technician come up with a reading of 0.02 ng/mL when his equipment cannot detect PSA at that level. Much the same happened to me a couple of years ago. The lab then used the Immulite 2000 which has a lower detection limit of 0.003 ng/mL. On two consecutive occasions they reported my result as <0.001ng/mL. A member here back then (I can't remember who) suggested I query them, as such a result was not possible on any equipment. I had my GP ask the lab how did they obtain a result of <0.001 given the lowest reading they can report is <0.003 (the limitation of the assay). After some foot shuffling they came back " the test was misreported". Just goes to show that some of the people doing these tests are not totally familiar with the capabilities of the equipment they are using. My suggestion is to find a lab that uses the Immulite 2000 (a very common apparatus). It's limit of detection is 0.003. Most labs will not report a 3 decimal place result even if that is the result they obtained because there can be a 20% variation on the same sample if tested more than once, but will simply say <0.01---------you can be pretty sure that if they are using that assay apparatus and it comes back as <0.01 then it truly is below that figure.

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Date Joined Apr 2008
Total Posts : 1382
   Posted 10/27/2010 3:48 PM (GMT -6)   
enjoy being in the zero club I personally think .02 is an excellent number. I am sure you are years away from being .2 so live it up.

peace to you

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Date Joined May 2009
Total Posts : 2691
   Posted 10/27/2010 8:16 PM (GMT -6)   

I'm with you. As a Gleason 9, I am as jumpy as a frog in the skillet. Any change in PSA makes me jump. I can buy this noise, calibration, naturally occuring PSA etc. to a point, but after 5 PSA readings at <.01, and then have one at .01, I am jumpy. Is this the start of the trend ?

My test report from the lab does state that .05 is considered BCR by the lab. So I am using that as my trigger point. When I hit .05, I'm jumping.

I do think I am getting a little less jumpy, and hopefully more resigned to the fact that I will most likely need more treatment.

Good luck, and just work on making every day a good one. Enjoy every moment.
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
15 month PSA <.01
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