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An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/9/2010 8:05 PM (GMT -6)   
 
My husband Paul had his ultrasensitive test repeated at 3 months, this time with 2 laboratories using different assays.
 
Results:
 
Lab1 (Prince Alfred) - DMC Immulite
8 weeks: 0.02
3 months: 0.03
 
Lab 2 (DHM)
3 months: 0.01
 
The GP, who has a lot of patients with prostectectomies, is used to seeing ongoing consistant <0.01 with most of his patients. He called the pathologist at DHM on his advice on how to interpret the results. The pathologist was straightforward in saying that with his test they almost always see a <0.01 at 3 months in cases where there is a "cure" following a prostetectomy and he recommends a retest in 2 weeks.
 
This was also the feedback from Prince Alfred when I called them 4 weeks ago. They believe they should also see a <0.01.
 
So my concerns are the change of 0.02 to 0.03 - I understand that in the best case the numbers could be 0.024 to 0.026, but still I was fully expecting the numbers to trend down. Although Paul's results had negative margins (close at APEX), negative perineural invasion and negative SVI and 3+4 with only 5% of 4 and a low cancer volume of <0.5cc, I am not comfortable with Paul's numbers being so far from ultrasensitive undetectable and I am uncomfortable with the trend up. As are the GP and the pathologist.
 
I guess we will know more in a few weeks when Paul repeats his tests. I have fading hopes that they will go down - the best I think we can hope for is that they will stay stable at 0.02 or 0.03.
 
Regards,
An
 
NB: I believe in ultrasensitive tests and I have considered the issue of PSA anxiety, but I would rather know as early as possible if things are not going right.
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.
Post RP PSA, Sep10 – 0.02

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 12/9/2010 8:11 PM (GMT -6)   
that is an excellent PSA, I think you will find most people agree that .01, .02. or .03 is all about the same thing. It is still a zero. Do not get over concerned at this point. Celebrate being in the zero club.
congrats on the test

peace and love
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/9/2010 8:18 PM (GMT -6)   
i agree, you are worrying too much, those are all "zeros" and i would not be concerned about the minor variations at this point
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/9/2010 8:21 PM (GMT -6)   
Hi An, Still recon you should be chilling the champagne, all in all a great result I think, and certainly he has got his membership to the zero club. The movement is so small, could be due to lab noise or anything, but I do understand your concerns. Here's to hoping it does settle down, where it should be. I have been on 0.03 since surgery, found out thats the lowest my pathology people can report to. So who knows I could even be lower, but if it stays where it is, that's fine by me.....Rdgs 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%
Margin status- Focal Involvement
Nil - EPE
Dry less than 1 week. ED- okay with Meds.
PSA at 2 yrs, no change remains 0.03
"Everyday in Everyway, I get better"

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/9/2010 8:45 PM (GMT -6)   
Hi Kev,

Yes we are happy that we are less than 0.1 but we are concerned that the number we are getting on the ultrasensitive is so much higher than undetectable for that lab.

The difference between you and Paul having a 0.03 is that for you the 0.03 is the lowest your lab will report, whereas for Paul the lowest they will report is <0.01.
 
We really do hope it will settle down.

Regards,
An

creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 12/9/2010 9:14 PM (GMT -6)   
Dear An,
I am sorry for not posting much earlier - it has been one of those years!! eyes However I think you had the same surgeon as us (In Sydney),  and if s, o this is my suggestion. 1. email the nurse and discuss with her. 2. make an appointment with specialist. If he is the same one, he offers to "look after you for life". If that is so, test it like we did! You can see from our signature that we had exactly the same sort of trend. We made an appointment together and went through all the issues in 2008. We are now happy with .02 - .03 long-term and have skipped the Christmas PSA testing. I think now that you have got some conflicting info, it is time to consult the guy who did it specifically. Our GP also did not know. She had to be given lots of info from us (reading), then phoned specialist after he had met with us.... even if you did not have same guy this process worked for us. CJ has just passed 4 years from diagnosis and he is as fit as a fiddle. I can understand your anxiety - in fact, I will be the same next April, but, for the moment..... suggest email hus nurse with a summary of your concerns, and ask for a Thursday appointment - this is his fit people in day..... again sorry to just chip in with not much of a previous conversation, but knowing you are an Aussie, thought you may not mind. All the best, Lana  tongue   PS. I agree with others An _ this is a super result...... tongue but you need to be convinced of that too...it took me about 6 months to come to terms with what I am now comfortable with, but this took an appointment with the "man" himself... it is not a small issue - its huge, but also his nurse should be able to reassure you and comment specifically on it all in your case... so a few options to consider....
Creed_three (Lana) - with husband "CJ" now aged 52.5 yrs (49 years at diagnosis).
PSA (2002) 2.1. (2006) 3.5.  1 x 5% core of 12 positive at biopsy. Open Radical Prostatectomy with nerve sparing April 2007 Sydney, Australia. Gleeson 3 + 4 = 7. 2 x small multifocal lesions. Contained. Undetectable <.1 PSA since: June 2007-0.01, Oct 2007-0.02, April 2008-0.02: Oct 2008-0.03, Nov, 2008-0.02, April 2009-0.03, April 2010 - 0.03. 

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/9/2010 10:07 PM (GMT -6)   
Dear Lana,

Thanks so much for posting, your post helped heaps. It helps so much to have a fellow Aussie with a husband exactly the same age respond that used the same surgeon. And one that had a tiny amount of Gleason 6 upgraded to a Gleason 7 post-surgery.
I already called Jane (the nurse) and she suggests that we wait till we see the next PSA tests next month and see whether they show a trend upwards or whether they stay flat. If they go up again then we are to come in. I would be really happy with a 0.02-0.03 long term but at this stage we are not clear whether this will be the case or not. Which is why it is so uncomfortable - the only way we will know for sure is with time. Looking at CJ's stats I can see that our doctor would have done a similar careful nerve sparing operation - so maybe the outcomes will be similar (and I hope with all my heart it is).

Dale, David, thank you for your thoughts and I do understand that being under 0.1 is a privilege, there are many who do not get below that number. Certainly that is the glass half full and for that we are grateful.

Regards, and thank you all for the champagne celebration,

An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.
Post RP PSA, Sep10 – 0.02

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/9/2010 10:11 PM (GMT -6)   
An,

There could be some prostatic tissue left, particularly with the nerve sparing. This can still produce low amounts of PSA.

My URO also said that he expected <.01, and I have been good, so far. But I am also watching the numbers.

As has been said, .02 or .03 is good, but I would add that the Roche lab prints on the results that they consider .05 as the base level for re-occurence.

Good luck, and enjoy the holidays. Nothing we can do today to change what will happen in 3 weeks or 3 months. Just enjoy every day that you have is my motto.
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
15 month PSA <.01

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/10/2010 12:12 AM (GMT -6)   
An,
Although not the <0.01 you would have liked to have seen the numbers are still really, really low. Like Goodlife said, nerve sparing could well leave very small amounts of viable prostate tissue attached which may account for the reading. The best shot is to watch what happens over the coming months ........ it may well just bounce around at these very low levels for the next 30 years.
Bill

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/10/2010 3:27 AM (GMT -6)   
Hi Bill, Goodlife,

Thanks for posting, thanks for the support.

If the results came back, as both of yours did at <0.01 at 3 months then I would be doing backflips in happiness right now, even though I would be aware that things could change in the future. This is simply because this would be the best result I could expect given the circumstances.

This is not the case at the moment so it feels like its not the worst news, its not the best news and we just have to wait to see how things are. I am a little more worried than I was a week ago and I am a little less positive probably because I was confident that Paul hadn't reached his nadir yet and the numbers would go down. Hopefully I'll bounce back tomorrow. My husband is more a glass half full person than me so he is less worried till he sees a definate trend.

I hate cancer.

An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03
Lab 2: Nov 10 - 0.01

Post Edited (An38) : 12/10/2010 5:12:18 AM (GMT-7)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 12/10/2010 6:11 AM (GMT -6)   

An, analyzing ultrasensitive PSA tests is way above my pay grade so I won't try.  All I will say is based on the results I have seen reported on this forum over the past two years that Paul's numbers look very good.  I'll be on the lookout for your next report and wish you both the best and a lifetime of zeros.

Tudpock (Jim)


Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 208
   Posted 12/10/2010 10:50 AM (GMT -6)   
Hi An,
 
I wish I could just tell you not to worry, but that's what we wives do.  But, I do agree with the above-his numbers are still excellent.   I have seen this happen on the forum before- I think Sephie's husband's numbers went up and then back down-maybe she'll pipe in.  Hopefully his next test will stay the same or go down, but as was noted above with nerve sparing there is probably always going to be some psa. 
 
Geoff, who was also due for his 3 month, put it off till next month as he is very busy at work and also out of town on business.  I was a bit relieved but now will worry till Jan.  He never seems to worry.  A friend who was just diagnosed asked him what his gleason score was and he said, "You'll have to ask Renee-she took care of everything and I really can't remember."  When he told me this I couldn't believe it!!  Wish I could be so easy going.
 
Anyway, you and Paul are in my thoughts-wish I could wave a magic wand and make you quit worrying.
 
Your August pal,
 
Renee

natural44
Regular Member


Date Joined Dec 2010
Total Posts : 172
   Posted 12/10/2010 3:25 PM (GMT -6)   
I have to agree with everyone else here.  Anything less than 0.15 is considered to be "undetectable" and thus a "0".  and the difference from one lab to another is why you should always stay with the same lab everytime for this ultra sensative testing. There will be a varience from lab to lab and the margin or error on the test is 0.02  so I would not worry at all about even a 0.03 reading!  
 
Be blessed and relax

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/10/2010 10:12 PM (GMT -6)   
Natural,
 
Not sure where you heard the .15 number, but I would disagree.  The Roche company who is one of the ultrasensitive test developers with electrichemicalluminesence technique states that .05 is considered the baseline for BCR.
 
Goodlife

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/12/2010 1:09 AM (GMT -6)   
Tud, thanks for your post and good wishes.

Renee, I don't think I am worrying needlessly, this is a situation that needs careful following I think. I wish Geoff and you all the best with the results next month.

Natural, although we are using two labs we are not comparing results between labs. And we do the tests simulataneously at the two labs so that we get two data points instead of one at each point in time. Our surgeon has said that for him the threshhold is 0.05.

Regards,
An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03
Lab 2: Nov 10 - 0.01
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