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less than .1 VS less than .01?

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browntrout
Veteran Member
Joined : Apr 2014
Posts : 683
Posted 1/22/2019 2:10 PM (GMT -8)
Ok, my PSA readings have been great and may still be great but piece of mind is at stake. I have been blessed to have a steady drop in PSA readings since 2014 LDR Brachy. Last two were .04 and less than .01. Now, a different lab sends me a reading of less than .1 which MD says don't worry because less than .1 could cover the mathematical range from 0.00 to .1 I have read the various posts on the new evidence that .003 or higher could mean recurrence but have not been too excited about those readings in my RT treatment option.

Your thoughts please.
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F8
Veteran Member
Joined : Feb 2010
Posts : 5775
Posted 1/22/2019 2:32 PM (GMT -8)
i'm in my ninth year of remission. my PSA is .1, which is the lowest reading from LabCorp.
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PDL17
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Joined : Oct 2011
Posts : 686
Posted 1/22/2019 2:35 PM (GMT -8)
It looks like to me you had the traditional PSA test rather than the ultrasensitive one. The one you have only measures to 0.1 and can not accurately measure numbers as low as .01-1. I don't think brachytherapy patients need to be tested with the ultrasensitive test. Using the .003 value (this is controversial for surgery patients as well) as a standard for recurrence is meant to be used for surgery patients since their PSA's should be close to zero. A radiation patient will often have a nadir PSA significantly higher than 0 in most cases. Many recommend the radiation nadir to be < 0.5. However, many patients have nadirs higher than that without recurrence. The definition of recurrence is a PSA increase of 2 greater than your nadir. The fact your PSA was less than .01 for a radiation patient is extraordinary.

You have nothing to worry about.

Paul
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ddyss
Veteran Member
Joined : Apr 2017
Posts : 500
Posted 1/22/2019 3:58 PM (GMT -8)
I echo what others have said.

Two consecutive uPSA reading of 0.03 or higher could mean BCR -but that’s for folks after Surgery.

Since you had BT , that theory ( albeit controversial) is not valid for you.

My 2 cents is that you are good to go with a reading of <0.1 !!!
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InTheShop
Elite Member
Joined : Jan 2012
Posts : 11468
Posted 1/22/2019 4:36 PM (GMT -8)
BRC post RT is nadir +2 so you would need to take any action until your PSA rises above 2.

the digits below .1 aren't going to be helpful to you.

Don't worry, be happy, live life!!!
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Ed C. (Old67)
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Joined : Jan 2009
Posts : 2543
Posted 1/22/2019 4:43 PM (GMT -8)
I had surgery in 2/2009 and my ultra sensitive PSA was <.01 for 8 years. in 2018 it came back as .03. My urologist is recommending that I see an oncologist because he believes it may be BCR.
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Tudpock18
Forum Moderator
Joined : Sep 2008
Posts : 5433
Posted 1/22/2019 4:46 PM (GMT -8)
Trout, I also echo the others. Looks like your new lab only measures to "Below .1". In 10 years I have never had an ultrasensitive test and am delighted be be less than .1. The somewhat controversial .03 standard is for surgery guys -- not you and me. Any nadirs around the .1 level are simply fantastic for us brachy guys so don't worry, be happy.

Jim
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Purgatory
Elite Member
Joined : Oct 2008
Posts : 25448
Posted 1/22/2019 8:24 PM (GMT -8)
you are making the classic case for the dangers of ultra sensitive testing. if you are under .10, feel fortunate.
who said .003 is evidence of BCR? that doesn't sound correct or sensible to what I have learned the past 10 years.
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logoslidat
Veteran Member
Joined : Sep 2009
Posts : 7585
Posted 1/22/2019 9:21 PM (GMT -8)
The .03 recurrence is a legacy of a bad idea...gone bad...hatched and fried...basted and wasted...by well in tent ioned...but...frankly...well I wont go there...there are some members who still keep it in their pocket...just...its difficult to be wrong...but actually more difficult to be right...such is life in Chinatown...or in The Naked City...whatever generation you have applied to...oh btw purgatory pdl17 made a decimal error...and browntrout…>.01 is inc lusive to >.1...even tho none of this...distraction of decimals apply to you...listen to the rt nadir kind....oh the confusion of well intended...Like I used tell to rookie controllers who were supposed to help me...in pidgon...Hey...help...no help!!!
forums are great...just member the telephone game in the big tent...it is inclusive to EVERYTHING

Umm have I used the word inclusive correctly here ...if not use the ole context schtick...it can mean what ever you want it to mean
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browntrout
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Joined : Apr 2014
Posts : 683
Posted 1/23/2019 10:20 AM (GMT -8)
Thanks for all the supportive commentary and valuable information. I looked closely at the LabCorp info and read "Roche ECLIA methodology". Quick blackle seemed to indicate that test was done to display PSA and free PSA outcomes but not much more. Was hoping it would reveal explanatory info on ultra sensitive or the lack of readings.

Apparently LabCorp is yet one more corporation that eats up smaller corporations.
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Big Mac
Veteran Member
Joined : Jul 2012
Posts : 2036
Posted 2/23/2019 1:21 AM (GMT -8)
I have been using LabCorp for several years and they will test below <0.1
IF your doctor request “Ultrasensitive testing” on the scrip.

Bill from California
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halbert
Veteran Member
Joined : Dec 2014
Posts : 5849
Posted 2/23/2019 3:14 AM (GMT -8)
As others have said...the 0.03 'rule' is for surgery patients, not radiation patients. You still have a prostate, and it can still, in it's cooked state, put out some PSA. Keep getting the 'standard' test and fuggetaboutit
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Mumbo
Veteran Member
Joined : Nov 2018
Posts : 2172
Posted 2/25/2019 5:40 AM (GMT -8)
Halbert er al. - Can you point me in a direction to read about the different PSA thresholds mentioned for radiation and surgery? I would like to understand how this was developed and what the thinking is?
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halbert
Veteran Member
Joined : Dec 2014
Posts : 5849
Posted 2/25/2019 10:25 AM (GMT -8)
Mumbo, I'm not a repository of links to research--but here's my understanding, for what it's worth:

Not all that many years ago (15-20), there was PSA. It had a low detection limit of 0.1. So, for all cases, "cure" was defined as <0.1. Also, 15-20 years ago, there was surgery--and surgery--and surgery.

As the PSA test has gotten better (or at least lower detection limits), the definitions of what to look for have also gotten refined. The problem is noise. At the very low levels that we are now seeing....things like <0.006....the scatter due to 'noise' can be significant. Again, the only way anyone can achieve those kinds of levels is if there is NO active prostate tissue in the body, at all. And surgery is the only way to make that happen.

Now, for radiation patients: With radiation, the PSA will go down over time. Sometimes a long time--a year or more. Because the gland is still there, the healthy remaining tissue is generating PSA. So, it's rare to go non-detectable. Now, with ADT in the mix, which deactivates--but does not kill--the remaining tissue, the PSA can get to the non-detect levels, sometimes.

I'm not a radiation patient, so I've never had this conversation with a doctor. What I surmise is that the important thing for the radiation patient is to keep track and note the trend downwards, and see where it settles--this is called nadir. It will be a positive value, but not zero--and it will depend on the patient where it lands. To determine recurrence, then, one has to define a value for a cancer-caused increase--whatever it might be.

In both cases, the perspective is to figure out two things: 1. Is what we are seeing real and due to cancer? and 2. At what point of increase do we have the best chance at cure without creating more trouble? And that, fundamentally, where those numbers come from.
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PDL17
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Joined : Oct 2011
Posts : 686
Posted 2/25/2019 11:44 AM (GMT -8)
Studies have shown that in radiation patients, PSAs less than 0.5 increases the potential of cure. Other references have inferred nadirs less than 0.2 increases the potential of cure. However, the guy I had that did my brachytherapy claims he has seen patients with PSA nadirs around 2 and never had recurrence. He did say that most of his cures occurred at PSAs below 0.5.
Therefore, you can see that you are in great shape.

Paul
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Depov
Regular Member
Joined : Jul 2016
Posts : 103
Posted 2/26/2019 8:39 AM (GMT -8)
Obviously there are different thoughts on the post-surgery PSA test. I just received my first test today, 6 weeks out, and it said <0.1. I guess my doc is not so interested in the ultra-sensitive test. I see him tomorrow, so it will be a good question to ask.

Thanks for this thread.

Post Edited (Depov) : 2/26/2019 9:44:53 AM (GMT-7)

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PDL17
Veteran Member
Joined : Oct 2011
Posts : 686
Posted 2/26/2019 9:26 AM (GMT -8)
In my opinion, all surgery patients should be test with the ultra-sensitive technology and all radiation patients should not.

Paul
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halbert
Veteran Member
Joined : Dec 2014
Posts : 5849
Posted 2/26/2019 10:17 AM (GMT -8)
Paul, I have my doubts, given the inherent instability of the Ultrasensitive test, whether it is particularly useful for surgery patients. Currently, where I get mine, they go to <0.006. Next, I'm sure, someone will come up with a way to get to <0.002, and after that, <0.0005 or something. Where does it stop? And, more importantly, what does it really mean?
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Pratoman
Forum Moderator
Joined : Nov 2012
Posts : 9453
Posted 2/26/2019 12:03 PM (GMT -8)
Hal, I’d agree with you in theory. But I think uPSA can be valuable in revealing a trend, thus hitting it earlier if salvage is needed.
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Blackjack
Veteran Member
Joined : Sep 2017
Posts : 805
Posted 2/26/2019 12:52 PM (GMT -8)
I echo PDL17’s comment that “The fact your PSA was less than .01 for a radiation patient is extraordinary,” and then also InTheShop’s comment that “the digits below .1 aren't going to be helpful to you,” and ultimately halbert’s suggestion “Keep getting the 'standard' test and fuggetaboutit.”

Most of the other comments here should be ignored as they have inappropriately mixed PSA monitoring guidance into a one-size-fits-all approach when one-size-DOES NOT-fit-all.

First and foremost, and obvious to most, is that PSA monitoring for primary surgery patients and primary radiation patients is completely different…and don’t belong in the same conversation.

Second, there are significant differences between external beam and brachytherapy guidance for post-treatment PSA monitoring…their results (and the patterns of PSA decline & bounce) are typically different. PSA nadirs following EBRT to undetectable levels are uncommon because this technique does not fully ablate normal prostate tissue; PSA nadir to 0.5ng/mL predicts low rates of BCR. On the other hand, 90% of BT patients reach a nadir of less than 0.5 ng/mL, with a median value of 0.10 ng/mL when measured with ultrasensitive PSA testing (for study purposes). SBRT typical nadir is between EBRT and BT; closer to BT.

Regardless of the specific RT technique, the (“Phoenix”) definition of BCR remains the same: nadir + 2ng/mL…which is more than an order of magnitude greater than the “standard” PSA test lower limit of 0.1ng/mL. The ultrasensitive PSA test for radiation patients is clearly unnecessary.



Off-topic: There needs to be a specific REASON to justify prescribing the ultrasensitive PSA monitoring test to primary surgical patients…most commonly a good reason is unfavorable surgical pathology. Unless there is a good reason for a surgical patient to have the ultrasonic PSA monitoring test, then the standard test is the right choice.
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logoslidat
Veteran Member
Joined : Sep 2009
Posts : 7585
Posted 2/26/2019 5:46 PM (GMT -8)
no way jose...on<0.01...browntrout has difficulties with decimal points...period(pun intended) as well the difference tween cataracts and glaucoma...he is mad at me for...pointing...this out but at close to 76 as I be...well you get the...drum roll/cymbal clash...point.....toodles...
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oldbeek
Regular Member
Joined : Sep 2017
Posts : 410
Posted 2/26/2019 6:40 PM (GMT -8)

Depov said...
Obviously there are different thoughts on the post-surgery PSA test. I just received my first test today, 6 weeks out, and it said <0.1. I guess my doc is not so interested in the ultra-sensitive test. I see him tomorrow, so it will be a good question to ask.

Thanks for this thread.


Tell doc you want a uPSA. I use Primco lab all there PSA tests are uPSA. I know labcorp only goes down to <.1
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browntrout
Veteran Member
Joined : Apr 2014
Posts : 683
Posted 2/26/2019 7:00 PM (GMT -8)
I'm not sure where I made an error in posting info on decimals. My info comes straight from documentation given to me by lab reports. I am not mad at anyone on this board and never have been. My thoughts on eye pressure were tempered by saying that my case was unique and that most did not have this issue. If I am guilty of your perceptions than so be it. I post infrequently on this board with only helpful intentions. Apparently I have offended instead and for that I apologize.
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logoslidat
Veteran Member
Joined : Sep 2009
Posts : 7585
Posted 2/26/2019 8:42 PM (GMT -8)
Since you are referring to me browntrout...you have not offended me one bit...I will stand by the < 0.01 as someone's mistake with numbers...at this point...it really doesn't matter and probably never did who.. I was actually hoping beyond hope that someone would contradict me with a reasonable explanation as to how the < 0.01 happened...I love criticism (but then again there are no absolutes thankfully)...its a great way to learn...I am actually still hoping for that reasonable...and again no BS explanation...please some one do not create a straw man...named surgery...ya gots to admit the original thread post had a multitude of errors with decimals... and other misinformation...such is the curse of forums such as these...I try to correct them...but it is so commonplace here...that well...one does what one does...caveat emptor...I also try to redefine support...there is no fine line between support and enabling...there is a chasm/abyss/infinitude...I want to say endless summer..so did...but of course that's silly...but breaks the ice...wait that would be an endless...er never mind
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