Variations in PSA after surgery

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Terry Herbert
Regular Member


Date Joined Sep 2010
Total Posts : 92
   Posted 2/28/2011 6:38 PM (GMT -6)   
Every now and then there are discussion about the theoretical level of ultra-sensitive tests after surgery and when these should trigger salvage therapy such as EBRT (External Beam Radiation Treatment) or ADT (Androgen Deprivation Therapy).

There are many views on this matter and some of them are illustrated in the latest update from Yana contributor which you can read at Doug Harvey

Briefly a rising PSA which hit 0.29 ng/ml triggered a decision by his medical advisor that he should have EBRT He went for a second opinion at another institution where they had differing criteria for commencing EBRT after surgery.

He had a number of PSA tests during this process, none of which agreed, but which had a range from 0.29 ng/ml to 0.03 ng/ml – Oh! and his Gleason Score, which had been upgraded from 3+4=7 to 4+3=7 after his surgery was downgraded back to 3+4=7 – that was good news, but his post operative staging was also changed from pT2c to pT3a

This is anecdotal and dismissed by many for that reason but I believe it illustrates a number of points, the main ones being the lack of agreement between experts and the lack of accuracy in PSA tests - something that newbies are often not fully briefed on.
Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony Metastasis: Aug '07: Intermittent ADT: PSA 2.3 Aug '10

It is a tragedy of the world that no one knows what he doesn’t know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/28/2011 6:46 PM (GMT -6)   
Good points, Terry,
I have seen much to do made about ultra sensitive tests but con't see why anyone would want them. That's just my thought about them. They, in my opinion, show that they can accurately display the inaccuracy of the basic Bayer Assay PSA test. But some guys feel better knowing the more detailed version, they just need to understand that no form of the test is completely accurate.

That is an interesting ride that Doug has been on.

For me I am glad my reading is <0.1. If it were 0.09 I believe that I would be doing needless early worrying...but not treatment....not yet at least

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/1/2011 6:03 AM (GMT -6)   
Great post Terry H., hope the message resonates.

Putt
Regular Member


Date Joined Aug 2010
Total Posts : 154
   Posted 3/1/2011 7:12 PM (GMT -6)   
Gentlemen
I don't use the ultra test to ponder over what would have or what should have.  I recognize the fact that I have PC.  I will always have PC.  My goal is to control it in whatever manner I have available, for as long as I can.  Using the 3 or 4 months test allow me the option of planning events in my life that I wish to participate in.  Having experienced ADT once, and will return to it when its time, I can get a good idea whether its going to be weeks, months, or years, before the effects of ADT will once again restrict my activities.  This is a personal choice and I wouldn't suggest others follow, however, it is an option, for whats it worth, to those that may be interested.

PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3bc NO MO, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.42, 12/10 0.47. Will start ADT3 after PSA reaches 1.2.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/1/2011 7:16 PM (GMT -6)   
Terry,

Good post and good point. One I have tried to make here, as if the experts can't agree at times, what's a patient really suppose to do, when ultimately any treatment decision will by made by the patient himself?

David in SC
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

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/2/2011 1:24 PM (GMT -6)   
Terry Herbert said...

This is anecdotal and dismissed by many for that reason but I believe it illustrates a number of points, the main ones being the lack of agreement between experts and the lack of accuracy in PSA tests - something that newbies are often not fully briefed on.
 
 
Indeed anecdotal, but I think that a main lesson here was that if a single PSA test result look stangely out of range (which was the situation in the Doug Harvey case), then it's highly possible that a lab/reporting error exists.  This is, of course, precisely why the AUA Guidelines for Biochemical Recurrence is stated this way (with bold emphasis added by me):

"...an initial PSA value 0.2 ng/mL followed by a subsequent confirmatory PSA value 0.2 ng/mL..."

Most of Doug Harvey's other variation is in the range of the naturally occuring variation of PSA (a different concept than test accuracy).  There is lots written about the "PSA anxiety" which the ultrasensitive PSA test can cause when the naturally occuring variation causes results to bounce around...but the point is appropriately noted that newbies need to be advised about this natural variation if they/their doctors choose the ultrasensitive PSA test. 

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