The < fell off, am I over reacting with worry? or just wait for the next test?

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Regular Member

Date Joined Dec 2015
Total Posts : 50
   Posted 6/21/2017 6:17 AM (GMT -6)   
The < fell off, am I over reacting with worry?

Tuesday 6/13/17 I went for my PSA draw and since I had an appointment a week later with my MO, I asked my URO if he could have his lab perform the additional blood tests for my MO visit and he said yes without an additional fee.

Normally I get the PSA results back in a day or less on line, but after 2 days of no PSA results, I called the URO’s office to find out NO PSA WAS DONE?, only the 2 worthless blood test for the MO were done! So Thursday I drove 220 miles RT back to the URO’s office and had the PSA done. On Friday afternoon the results were not on line, so I called my URO’s office and the doctor’s nurse told me my PSA was undetectable and was the same as the last 2 draws at <0.020.

Monday evening I saw my PSA results on line and the < fell off, it went from <0.020 to 0.020. Yesterday I stated calling the URO’s office to clarify this and the nurse and doctor were both out, but the office staff did state the results were 0.020 and that was good. I told the staff member the PSA result was an increase over the last 2 tests and the staff member said I would have to talk to the doctor’s nurse about it and the doctor and nurse would be in today. The staff member said she would have the nurse call me today.

My MO visit got pushed back till July 7.

I have meetings all day today and tomorrow, so likely my return call will go to voice mail and I will be playing phone tag for days.

I drove back to the URO’s office so that the same lab would be usedfor the PSA. Am I over reacting to this PSA test result? Or should I take a pill and forget about it till the next test?

Final Path after October 13, 2015 surgery:
All 17 lymph nodes were negative.

Prostate size: 4.1 x 3.7 x 4.9 cm

Prostate weight: 53 grams

Total GS 9 (4+5=9)

40% of the prostate involved

Seminal vesicles invasion: Identified

Margins: Minute focus of left posterior margin involved by the tumor. In the right and left apex there is focus approaching the edge, but due to the absence of ink in the portion, it cannot be definitively said that it is a true margin

Perineural invasion: Present, extensive

Path staging: pT3Bno

PSA 7/29/2015 6.76, 11/11/15 0.044, 1/19/16 0.041. Radiation completed Mid May 2016, PSA 5/25/16 0.026, 10/18/16 <0.020, 3/2/17 <0.020, 6/15/17 0.020

Veteran Member

Date Joined May 2011
Total Posts : 1313
   Posted 6/21/2017 7:50 AM (GMT -6)   
You are over reacting and doing great so far.

Forum Moderator

Date Joined Jul 2012
Total Posts : 6076
   Posted 6/21/2017 7:55 AM (GMT -6)   

We have guys here who actually know how the machines work so I have to be careful about making things up since there is a penalty for guessing, but here's what I am fairly sure I know: The machines that measure PSA are more precise than accurate. The machine reads the sample to more decimal points than they report -- four, maybe five, places after the dot. That last digit is pretty meaningless in real-world situations so they round (truncate?) the number to the number of digits that they are sure of. This means that there are two numbers that differ by a single increment in that last unreported digit where one of them gives the less than sign and the other doesn't. For your 0.020 reading, if they truncate then those numbers are 0.02000 and 0.01999 (if they round, 0.01995 and 0.01994). That last digit difference could be a mouse farting in the lab or cosmic rays. So when you lose your less-than sign you don't know that anything has actually changed about your PSA. But you don't know that it hasn't.

If you were a Gleason 6 guy I would tell you, yes, you are overreacting. But you're not and you're not. It's a worry. Not much you can do right now. Wait a bit. Retest and see. This is a good time to fill your Rolodex with radiation oncologists so you are ready but, aside from that, take that pill and worry as little as you can.
63 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

Veteran Member

Date Joined Jul 2010
Total Posts : 3889
   Posted 6/21/2017 9:11 AM (GMT -6)   
Stop worrying ! 220 miles to get a PSA test ? You must have a lab closer than that...Most labs will do a walk-in blood draw and test without a prescription so you can get a PSA test done anytime you want but WHY??? Don't let yourself become a PSA slave...Don't worry about things you can't do anything about....
Age now 74 . Diagnosed G-9 6/2010
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA <0.1 10/'11, <0.1 2/12, <0.1, 4/12 <0.1, 9/12, 0.8 3/13, 0.5 6/13, 1.1, back on HT. 5/16 stay the course, Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..

Veteran Member

Date Joined Jan 2012
Total Posts : 9399
   Posted 6/21/2017 11:54 AM (GMT -6)   
I vote for, no worry, retest, and maybe a nice dinner at a good restaurant.
I'll be in the shop.
Age 57, 52 at DX
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Tall Allen
Elite Member

Date Joined Jul 2012
Total Posts : 10645
   Posted 6/21/2017 1:54 PM (GMT -6)   
I can see how that would be troubling, and your reaction is normal and understandable. As PDA said, the reading is right on the edge of detectability, and on repeat, may be non-detectable. Let's go with that for now.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Regular Member

Date Joined May 2017
Total Posts : 262
   Posted 6/21/2017 3:40 PM (GMT -6)   
These fears and concerns are entirely normal.
Here's a very similar thread from a few years ago.

Dx Nov 2013 Metastatic Prostate Cancer at Age 65
Numerous Bone Mets and Lymph Nodes, PSA 5,006
ADT Lupron + Zometa, PSA Nadir 1.0
Resistance after two years.
Short rechallenge Casodex.
Oct 2016 Provenge
Dec 2016 Start Xtandi, PSA 95
May 2017 PSA 2.6

Regular Member

Date Joined Dec 2015
Total Posts : 50
   Posted 6/21/2017 5:44 PM (GMT -6)   

Thanks for the information, your post about Pads/ Wal-Mart and nobody cares brought me off the sidelines and to join in the conversations a while back in this great forum.

Based on your PSA testing comments and those of Tall Allen, I now understand that 0.020 is on the border and sneeze or a fart in the lab could bump the < sign off – so I am having a cold beer now and putting the issue to the side – till next time.

I have had several PSA’s drawn over the past 1.5 years at our local Pathology lab, but their results are always totally different than my URO’s lab…. No warm and fuzzy feelings about the local lab results, even though the local lab is the one that gave me my first elevated reading of 6.76. I am using my URO’s lab as the bench mark.

BTW, speaking of next time, at my URO visit last week, the URO said that based on the October and March results of being <0.020 he recommended pushing my visits out to 6 months vs. 3 months. Given my history and Pathology, do you guys think it is time to push the PSA draw out to 6 months vs. 3 months? I see the MO on July 7 and I guess he will weigh in on the subject as well, if not I will ask for his input.

Thanks everyone, I do read and listen to the post on this site as they truly help me cope.

Tall Allen
Elite Member

Date Joined Jul 2012
Total Posts : 10645
   Posted 6/21/2017 6:28 PM (GMT -6)   
It's really up to you. If you will feel more comfortable getting another 3 month PSA next time, you should. It's about peace of mind.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Jerry L.
Veteran Member

Date Joined Feb 2010
Total Posts : 3072
   Posted 6/21/2017 6:41 PM (GMT -6)   
A few years ago I recall my < went away as well only to find out that Labcorp changed their lower end sensitivity. It read .006 without the negative. This happened 2 months in a row (I get monthly psas done). After that I had < .015 for like the next 2 years.

Over the past 8 years I've seen some strange things with these labs and they are not always consistent.

Try not to let this rule the day. Monitor a trend, not a one time number.
11/09 Dx at Age 44 ----- 4.03
12/09 DaVinci Surgery,t3b,g9 <.05
2/10 Adj. Radiation ----------- <.05
3/11 PSA Rise/Scans/Spot ---- .09
on Pelvic Bone
4/11 HT/XGEVA/Spot Radiation -- .06
2011-2012: ADT3: 15 months
2013-2015: ADT3 VACATION #1: 36 Months
2016: Spot on Rib; .07; ADT3; Spot Rad
2017-?: ADT3 VACATION #2:

Regular Member

Date Joined Dec 2015
Total Posts : 50
   Posted 1/1/2018 8:21 PM (GMT -6)   
12/27/2017 - Saw the vampire - PSA was .026 so the less than sign did not return.

At least the rise was very slight from .020 last time in June, I guess?, I just don't know what to think about the latest test and it will six months before I will see the Doctor.

Next PSA draw is in six months from now.

Take care and Happy New Year

three 5's and a jack
Veteran Member

Date Joined Jul 2017
Total Posts : 512
   Posted 1/1/2018 8:37 PM (GMT -6)   
You might feel better getting a 3 month PSA instead of waiting for the six month. I know I would.

May all beings be well.
Looking for the 4th 5
69yo weight 7/1-283# on 12/18 220#
PSA 6.01 6/17 & 6.07 on 10/11/17 and 5.56 on 11/17/17
BX 8/04/17 DX 8/11/17 5/16 cores positive all on left
L mid/base 4/6 4+3=7 25%
L apex 1/2 3+4=7 30%
Sec opinion from UofW same GS7 but called overall 3+4=7
Markers and scans completed Dec 7/8 Completed SBRT Dec 22 3625 cGY in 5 fractions at Swedish in Seattle Dr. Robert Meier

Regular Member

Date Joined Mar 2015
Total Posts : 97
   Posted 1/3/2018 11:50 AM (GMT -6)   
These ultra sensitive test can be agonizing. I went to a traditional <0.1 test after
going through what you are. As you can see from my signature below, I'm in the higher
risk category.

I was using a <.01 and I got results from <.01 to .02 and even .03 one time.
Retested after and <.01 again...drove me crazy!

I decided that I won't do anything unless PSA is over 0.1 so, I moved to
non ultra-sensitive about 2 years ago...more Peace for sure.

I know not everyone agrees, but you have to find your own way through this stuff.
Rx (Age 54, 58 now). Jan. 2014 PSA 13.3 Biopsy - Gleason 7 (3+4).
RP Feb 12, 2014 Path: shocked! Gleason 7 (4+3) Sem Ves+ LN+ (1/22)
Stage: T3bN1
PSA 6wks <0.04, 4 months 0.06, 6 months 0.094.
Aug 2014 Lupron, Sept & Oct. 2014 SRT 39 Treatments.
PSA every three months; between: <0.01 - 0.01.
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