How sensitive are UK post op PSA tests?

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EnglishBob
Regular Member


Date Joined Jan 2011
Total Posts : 126
   Posted 2/10/2011 5:50 AM (GMT -6)   
Hi everyone,

I have my first post op PSA blood test after ORP next month, my surgery was 13th Dec and i wondered how sensitive the tests are in the UK. Even though we have good surgeons and hospitals, often some equipment will not be as up to date as in other countries due to the financial restraints and budget cuts implimented by our goverment :(

I know a lot of you guys publish low results due to the very good sensitivity of the lab equipment and was curious as to how low the count can go in UK labs.

Take care, Bob.
Age 58
Prostate problems since early 40s
Ed since early 40s
April 2007 biopsy & all clear
July 2010 prostate swollen more, psa up to 5.6 August 6.7
September Biopsy again
October 7th diagnosed cancer, Gleason grade 6 at 10% mass
December 13th 2010 open radical proctatectomy
Pathology results came back Gleason grade 7 at 12% mass BUT clear margins
Catheter out Jan 5th 2011

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4823
   Posted 2/10/2011 6:23 AM (GMT -6)   
How sensitive were your tests before surgey? Didn't you use them to help determine you needed surgery?
 
I'm guessing that no one has every done a study comparing test results from different countries. I'd also guess that the tests in the UK are more then adequate.

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1147
   Posted 2/10/2011 7:31 AM (GMT -6)   
The answer is that because the UK has a universal health system, they do have a systematic approach to testing and procuring the best PSA assays available. See below:

The UK government did a comparision of PSA assays in order to make good purchasing decisions in Feb 2010 and the results were published at this website. It is an impressive document created by your government.
http://www.immqas.org.uk/documents/TotalPSAAssays-EvaluationReport2010.pdf

As you can see several ultrasensitive tests have also been reviewed in this document.

I would not worry about budget cuts in the UK affecting your PSA test, which are some of the cheapest tests in the market. In australia they cost less than $20 to do an ultrasensitive test so I doubt this will be the focus.

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. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01

GooseDrankWine
New Member


Date Joined Dec 2010
Total Posts : 9
   Posted 2/10/2011 8:17 AM (GMT -6)   
They give me two decimal places, and that's whether I get it done at my GP or at my local NHS hospital (Chester).

EnglishBob
Regular Member


Date Joined Jan 2011
Total Posts : 126
   Posted 2/10/2011 9:10 AM (GMT -6)   
My pre op PSA tests where only ever to one decimal point, prior to my surgery i was tested as 5.6 which then jumped to 6.7, ive never seen mine go beyond one decimal point in the past.
Bob.
Age 58
Prostate problems since early 40s
Ed since early 40s
April 2007 biopsy & all clear
July 2010 prostate swollen more, psa up to 5.6 August 6.7
September Biopsy again
October 7th diagnosed cancer, Gleason grade 6 at 10% mass
December 13th 2010 open radical proctatectomy
Pathology results came back Gleason grade 7 at 12% mass BUT clear margins
Catheter out Jan 5th 2011

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2211
   Posted 2/10/2011 9:31 AM (GMT -6)   
When you get PSA tests before surgery they are often like yours, and there is no great benefit for the purpose of diagnosis to test to two decimals for such a degree of accuracy. Being told that you are 7.62 rather than 7.69 makes little difference, whereas after surgery there is a bit more of a difference between 0.02 and 0.09.

At my hospital/lab in Holland they are still only testing to one decimal taking the view that everything below 0.1 is okay and everything above 0.1 is not. And that once you are above 0.2 they start offering RT or HT etc.

And then once the cat is really out of the bag and you are up to high numbers there is again no great advantage to measure the differnce between 75.64 and 75.66.

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr CT
66Gy 28 Apr to 11 Jun 10
Tired + weird BMs
14 Sep 10 PSA <0.1
12 Jan 11 PSA <0.1
Erection OK

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6894
   Posted 2/10/2011 9:35 AM (GMT -6)   
Even in the US the test is what the doctor orders. My GP orders ultrasensitive (2 decimals) but my uro/surgeon only wants standard (1 decimal) and gets upset with me for getting the test at the GP.
 
The uro believes that ultrasensitive creates unneeded anxiety. Some here will tell you that misses opportunity to fight BCR earlier.
 
Both of the tests are in the $100 - $125 (retail, no insurance) range plus the cost of the nurse drawing the blood/office visit, so the total cost is not a real variable in the choice.
 
I've noted that from the GP, the test is run on the same equipment for both versions.
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