On the way out of zero club?

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reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/12/2011 8:25 PM (GMT -6)   
18 months since RRP and have been under .1 every three months. A year ago I had an ultrasensitive that was <.014. Just got another ultrasensitive and it was .053. Although still under .1 that's quite a jump. The doctor (not a urologist) said I should have another one in 3 months. Right now I feel a bit depressed, not sure I have the energy to go through this thing all over again. Guess I'll start reading about SRT though. I should have known that G4+3 with tertiary 5 is nothing to take lightly even with negative margins and a fairly low PSA of 5.6. That low .014 post RRP nadir sure had me feeling good, though.

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/12/2011 8:32 PM (GMT -6)   
As you can see from many here and on Yana, even if you do end up going that route, which is hardly determined, doing well is very common.

I haven't been through what many here have but I think the hardest time for us all is when we find out and those first few weeks. After that, we can deal with any of it.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/12/2011 8:47 PM (GMT -6)   
reachout - i understand your concern, your number is still great, let's see what that next one brings. good luck
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 2/11 1.24
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 9/10,

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6057
   Posted 4/13/2011 12:02 AM (GMT -6)   
I.m beginning to think the ultra test is like the, joke when I was in the Navy. They had an extra obstruction light left over after building the air field. So they built a tall obstruction and placed the light on it. Reachout is going thru exactly the anxiety that argues against the ultra. Someone please tell me what is the benefit , especially in light of , the lowest bcr # being, I think .1. I think we will see more and more of technologys " gains'' , in all fields, as time goes on, sitting on needless obstuctions.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/13/2011 7:34 AM (GMT -6)   
I should have listened to my urologist who told me to only get the standard test, which would have just shown <.1 undetectable. That's what I get all the time except once a year when I get a VA physical. Many of you guys know what the VA is like, they do it their way or the highway, and they use the ultrasensitive. It was great at the 6 month point when it was undetectable but now I'm paying the price.

So I guess I'll make an appointment with my urologist and see what he says to do, which I suspect is nothing, just go back to the standard test.

By the way, Purgatory, I feel silly reacting with this anxiety given what you've been through and how hard you've fought this thing. But the anxiety is what it is. I appreciate your remarks.

Post Edited (reachout) : 4/13/2011 7:18:26 AM (GMT-6)


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 4/13/2011 8:28 AM (GMT -6)   
Reachout, I understand your anxiety. I get the ultra sensitive test as well, up until my 21 months check up I was getting .004 and .005 which made me happy. My last one was at a different lab and it came back as <.008 which scared me. I'm due for another test in less than a week at my regular lab and my anxiety is up. I wish you the best on your next test.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

I use to be a fish
Regular Member


Date Joined Mar 2011
Total Posts : 57
   Posted 4/13/2011 8:49 AM (GMT -6)   
I remember reading about the ultrasensitive PSA test in Dr. Patrick Walsh's Guide to Surviving Prostate Cancer book.  On page 371 it says "After radical prostatectomy, we believe that the PSA level should be undetectable - less than 0.2ng/ml, although some urologists use a cutoff of 0.4 ng/ml. (Avoid the ultrasensitive PSA test; they're often more trouble than they're worth - see PSA Anxiety: The Downside of Ultrasentive Tests below.)"
 
On page 380 is a box "PSA ANXIETY: THE DOWNSIDE OF ULTRASENSITIVE TESTS". 
 
It's a whole page about the ultrasensitive tests, if you have the book or can get it, it might put your mind at ease to read about that test. 
 

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 4/13/2011 9:29 AM (GMT -6)   
Logo,

Some people like surprises, some people don't. With higher Gleasins, the ultra tsst gives us some warning, kind of like an idiot lite. If I wore earplugs, I wouldn't know my car had a problem until it quit.

For my own piece of mind, I like the ultra.

Goodlife

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/13/2011 11:49 AM (GMT -6)   
It's very much a personal thing. I like the ultra as well. The upside was that when my PSA went from <.01 to .07 I had 3 months warnig time to check out a RO and facilities for SRT. Next 3 month test came in at .28 and I was able to react immediately. I had appoints with my Uro, a radiation oncologist and two medical oncologists set up right away. These were doctors that I selected from research I had the time to do.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6057
   Posted 4/13/2011 11:59 AM (GMT -6)   
I just get frustrated when I see anxiety levels get so high over what imo is really low levels, I do understand the anxiety, In spite of my generally positive frame of mind, my 6 mos tests really , really test me. Goodlife, I hear you! Reachout, every journey is different and everyones anxiety is specific to them. If, I ever do get a true BCR, at my age and general health, I still will keep the faith as it were, if there are other plans, I,m not afraid to give up the pound of flesh. I think we all in different manifistations feel the same way, and thats a good thing.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/13/2011 12:00 PM (GMT -6)   
BB_Fan, good point, that's what I'm starting to do now -- learn about SRT and research doctors/ facilities in my area. Have to say, though, it's really really hard emotionally having to go through this again after I thought I would be free from this darned disease.

Your numbers look similar to mine up to that .50. I note you used HT prior to SRT, so I guess that's another decision to make. Hopefully my .5 is only a blip though I have a feeling in the pit of my stomach that it's the start of BCR.

fish, I went back and read that portion of Walsh's book. Frankly, it was not my decision to use the ultra, it was made for me by the VA. If they had asked me I would have chosen the standard, though I can see the value of getting an earlier start on possible problems.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 month detectable .05

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 4/13/2011 5:28 PM (GMT -6)   
Reachout,
That <0.014 is an unusual number. "Less than" 0.014 seems an odd way to express a PSA result. The "less than" symbol before a figure indicates the result is below the detection capability of the test equipment and therefore no PSA was detected. It strikes me as unusual because I have seen many results such as <0.04 or <0.01, (or even <.003 ---Immulite 2000, the absolute lowest level of detection), all of which mean the respective test result was below the detection capabilities of the particular assay used. If a patient were to receive a result of <.04 it means that PSA was not detected and that particular assay could only test down to a possible level of 0.04. Likewise all < "i.e. "less than" results. Was this latest test done by the same lab. I too am a fan of the ultrasensitve testing ------ (1) because I wanted an early warning (up to 2 years) of possible recurrence and (2) I am a stickler for the nitty-gritty of things.
Bill

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/13/2011 6:48 PM (GMT -6)   
BillyMac, the <.014 is what was reported on my VA hospital test a year ago. The doctor told me that meant my PSA was below the detectability threshold of the equipment, so that means .014 is the lowest the equipment can detect. Seems like an odd number to me as well, but that's what it says.

This year's test was done by the same VA hospital, so I assume (but can't be certain) that it was done by the same lab. This year they reported .053, and the doctor said that meant it was now detectable. That's consistent, since it's much higher than the equipment's detectability limit of .014. But this illustrates the problem with definition of undetectability. From what I've read, <0.1 is the standard definition of undetectable, probably defined with earlier equipment that could not read below that. Now, with ultrasensitive tests, you could say the PSA is detectable as far as the equipment is concerned (as in my case) but not detectable by the standard definition. I'm kind of a stickler too, and would like to see different words used, maybe "below sensitivity limit" for the former, and undetectable for the latter.

So the question remains, since 0.05 is detectable by the equipment but below the standard used for detectability, does it indicate a path to BCR? I won't know until the next test, but I can begin preparing in case it does.

I think I have a headache.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 month detectable .05
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