PSA Timing Advice

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rcroller
Regular Member


Date Joined May 2011
Total Posts : 326
   Posted 6/13/2011 8:40 AM (GMT -6)   
I posted a question a while back on PSA timing and apologize if it appears I'm being redundant but would like some advice.  Due for my 4 week post RP PSA this week Wednesday (28 days) and am still wondering if we're doing it too soon.  Only have one lab to use for insurance coverage and don't know what level of sensitivity they test to yet. Still not comfortable with the PSA timing (less than 30 days) and may debate @ my Uro appt. this Thursday before complying. Just wondered what others would do in this situation and how to deal with the Uro.  Don't want my Uro to see me as a "non-compliant" patient but do want my best shot at a good, accurate number since it'll be three months till the next covered PSA.  Any advice would be welcomed.  Thanks.
-Bob
Age 53- PSA 2/11 3.5
4/21/11 BX Path Report: 3 of 12 Left PCa , 3+3, 3+4, 4+4
4/29/11 Received PCa DX, G-8
5/18/11 open RP Performed, Right nerve bundle spared
5/24/11 Post Op Path Report: G-7(4+3) 7%, pT3a N0MX, EPE, PNI+, SVI-, Left margin <0.1mm from inked margin
6/1/11 Cath removed, Incontinence-No, ED-Yes.

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2670
   Posted 6/13/2011 8:53 AM (GMT -6)   
If I were  you, I would follow my uro's directions.  I might mention to him that 4 weeks seems a bit early, based on information I've received from others who've gone through the process and see how he responds, but it seems to me it's a minor issue and I wouldn't worry much about it, one way or the other.
 
There's more than one way to skin a cat.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 6/13/2011 9:07 AM (GMT -6)   
I don't think there's any problem here if you ask the same question again, or ask for clarification when you're feeling uncertain about something.
I think 30 days might almost put you a good position as, if you get a <0.1 then that's great, but if you don't, then it's not necessarily bad as there is still an excellent chance that you will get <0.1 at three months.
Sorry I can't help, or comment constructively, about the insurance issue as, being a Brit living in Holland, I have no knowledge of it.

Alf

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/13/2011 9:31 AM (GMT -6)   
Hi Bob,
 
There is "a science" to the decline in PSA that I'll help to explain.  Doctors probably don't do these calculations for each and every patient, but they probably do the rough math in their heads each time.  They probably do something like this:  "Wait 4-weeks for someone with low PSA (like you), or wait 6-weeks or 8-weeks for someone with higher PSA."  Other docs might just wait 6-weeks for everyone.  Here's how it works (please forgive me, but to save time I'm going to just copy/paste from an earlier post of mine):
 

There is a "science" behind the level of PSA decline after surgery...I'll explain how it works, but to answer your question there is no specific "normal psa 6 weeks out."  It depends primarily on one's PSA prior to surgery...the starting point.  Once the primary source of new PSA is removed (the prostate and seminal vesicles), then the PSA already in one's bloodstream diminshes over time.

Studies have been performed which show a distribution of how fast PSA diminishes, but in most men the "half-life" of PSA in one's blood after RP is 2-3 days.  So, if one's "starting point" at the time of surgery is 5 ng/mL (close to yours), and if one assumes a 3-day half-life, and if one assumes no additional source of PSA added into the bloodstream, then the PSA level would reduce like this:

5.0 ng/mL at time of surgery

2.5 ng/mL 3 days later

1.25 ng/mL 3 days later, 6 days after surgery

0.625 ng/mL 3 days later, 9 days after surgery

0.3125 ng/mL 3 days later, 12 days after surgery

0.15 ng/mL 3 days later, 15 days after surgery

0.08 ng/mL 3 days later, 18 days after surgery

0.04 ng/mL 3 days later, 21 days after surgery

etc., etc.

 

This is the "science" behind why surgeons prescribe the first PSA typically 6-8 weeks after surgery (some very conservative doctors want to wait longer...the longest I've heard of is 3 months).  There would be some statistical "outliers" to the 2-3 day typical half-life which would result in a longer time to diminish.

Of course, this half-life decline described above assumes no PSA is being added back into the bloodstream.  There are, however, secondary (minor) sources of PSA, however, which prevent any living, breathing man from every achieving "zero" PSA...the phrase "zero club" is a misnomer which sometimes causes undue worry in men when they hear that their PSA is something other than "zero."  Prostate cancer produces PSA.  But a common source of PSA after RP surgery is the neurovascular bundles which may have been safely left behind during surgery; they do produce a low level of PSA, and the amount produced varies from man-to-man.

 
 
 
BTW, I thought Ohio State's comment was actually good advice if you still want to add more "margin" to your result...

rcroller
Regular Member


Date Joined May 2011
Total Posts : 326
   Posted 6/13/2011 10:32 AM (GMT -6)   
Thanks, I appreciate the replies...will go ahead and giterdone on Wed. as planned. I still won't know the result for a few more days, certainly not by the Thurs. Uro appt. but still have reason to go since he promised we're going to talk about erections. :)
-Bob
Age 53- PSA 2/11 3.5
4/21/11 BX Path Report: 3 of 12 Left PCa , 3+3, 3+4, 4+4
4/29/11 Received PCa DX, G-8
5/18/11 open RP Performed, Right nerve bundle spared
5/24/11 Post Op Path Report: G-7(4+3) 7%, pT3a N0MX, EPE, PNI+, SVI-, Left margin <0.1mm from inked margin
6/1/11 Cath removed, Incontinence-No, ED-Yes.
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