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Ultrasensitive PSA test that is more precise than <0.05?

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PGduane
Regular Member
Joined : Aug 2018
Posts : 50
Posted 1/28/2019 3:59 PM (GMT -8)
Hi All, Hope this isn't a rookie question but I couldn't find an answer in the old posts.

My question is whether I should ask for a more precise PSA test than undetectable <0.05. My MO at Stanford said this is their standard ultra sensitive test and I should continue tests at their lab.

Still, I often see references to scores between 0.05 and 0.01 hence I'm wondering where I am on the spectrum. A more precise score probably wouldn't change my immediate treatment plans (EBRT + 12-18 months of ADT+Zytiga), but I've seen studies that show better odds based on nadir (and scores <0.05 so I assume a <0.01 is better than a <0.05.

Thanks in advance for any insights.
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InTheShop
Elite Member
Joined : Jan 2012
Posts : 11468
Posted 1/28/2019 4:12 PM (GMT -8)
more precision doesn't lead to better decisions or better information on the progress or lack of it in your case.

The question to you is, at what PSA level would you undertake new or change your treatments?

Post RT BCR is considered nidar +2. The extra precision isn't likely to matter. Post ADT, your PSA will likely rise above .05 and still be considered okay.

I'd follow the advice of your MO - good enough is often good enough.
Andrew
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Pratoman
Forum Moderator
Joined : Nov 2012
Posts : 9453
Posted 1/28/2019 4:44 PM (GMT -8)
FWIW, MSKCC also uses <.05 as the undetectable limit. I believe that it’s because they believe anything lower doesn’t mean much in the context of recurrence .
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garyi
Veteran Member
Joined : Jun 2017
Posts : 2244
Posted 1/28/2019 9:58 PM (GMT -8)

InTheShop said...

I'd follow the advice of your MO.....

.....and Stanford is a fair to middling hospital. ;-)
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JNF
Veteran Member
Joined : Dec 2010
Posts : 5773
Posted 1/29/2019 1:20 AM (GMT -8)
Andrew, he started with surgery, which failed, then added ADT and SRT. Thus the nadir plus 2 isn’t germane.

Duane, the level of testing you are on is fine. I know you are still treating for a cure. Expect your PSA to be undetectable (regardless of regular, sensitive or ultra sensitive) while on ADT. That shows the ADT is working. The challenge will be when you come off of ADT.
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jasperx10
Regular Member
Joined : Nov 2018
Posts : 150
Posted 1/29/2019 1:30 AM (GMT -8)
I'd be asking for a more precise psa test. It just gives you more time to make a decision if a rising trend does show up. My hospital tests down to 0.008 and it just gives you more time to plan if a rising psa shows up. Most don't do anything till 0.05 or more, but still I prefer to know what's going on a little earlier.
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halbert
Veteran Member
Joined : Dec 2014
Posts : 5850
Posted 1/29/2019 3:59 AM (GMT -8)
IMO, you're fine. Yes, there are some docs (a relative few), who want to call out BCR at 0.03. Most, however, subscribe to the general concept of "2 or 3 successive rises above the detection limit"--so whatever the detection limit is, the wait for that line to be crossed, then wait a bit for a re-test, then another time after that.

The idea is to eliminate noise. And, the lower the detection limit, the more likely noise is going to be. And, as we've seen in here, noise drives some guys nuts. My current lab (Labcorp) runs a detection limit of 0.006. Previously, where I lived, the best they had was 0.04. Yes, it appears that now I'm "more undetectable", but I also know that if it starts to move, I probably won't do anything until it gets somewhere close to 0.1 anyway.

And, here is where I put on my analytical chemist hat, and point out that the OP is asking about precision, where he really means detection limit. And now I'll take that hat back off and spare the lecture about limits of precision, relative accuracy, detection limits, and other statistical functions relative to chemical analysis.
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JNF
Veteran Member
Joined : Dec 2010
Posts : 5773
Posted 1/29/2019 4:20 AM (GMT -8)
Guys, if you read Duane’s signature you will see that his first post surgery PSA was 4.0 and followed by a 4.5. One didn’t need more test sensitivity to know the surgery failed and that further treatment was necessary. Then scans showed lymph node involvement which prompted very aggressive ADT and SRT. Now the ADT has arrested the cancer, thus the latest undetectable PSA, thank goodness.

Hopefully the SRT to the prostate bed and lymph nodes will be curative, but it will take potentially years to determine that. If the disease is systemic then he will know that after the ADT is done by PSA rise, regardless of the level of sensitivity. The first clue is the loss of the < sign. Let’s all keep our fingers crossed and trust that the current aggressive treatment course will work for Duane.

Any rise now while on ADT will signal hormone refractory disease and call for something different to be added like taxotere on start an immunotherapy like Provenge. But, any level of sensitivity will be useful and none would be necessarily superior.
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alephnull
Veteran Member
Joined : Dec 2013
Posts : 2482
Posted 1/29/2019 8:04 AM (GMT -8)
IMNSHO
You are fine, as treatment won't restart/start until PSA reaches a much higher level.

For the first two years I was being tested where undetectable was <0.1 ,
then I asked for a greater sensitivity and I immediately saw my PSA hovering just below 0.1 at 0.08.
Made my life more stressful.
No new treatment, just watch the ball bounce incessantly.
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Bohemond
Veteran Member
Joined : Apr 2012
Posts : 1453
Posted 1/29/2019 9:01 AM (GMT -8)
The ADT plus Zytiga is clearly working - it reduced your PSA from 4.5 to <.05 in less than two months. That's great news. That combined with the SRT still offers a chance of cure. But even if PSA begins rising again after you are off ADT / Zytiga, you know that treatment has worked for you and will most likely work again in the future. FWIW the test sensitivity at Dana Farber goes down to .02 as the lowest detectable PSA. But whether .05 or .02 the important thing is that you dropped almost immediately to the test's undetectable limit. You are highly likely to stay there as long as you are on ADT and you still have a good chance of remaining undetectable after ADT ends if the SRT proves successful.
Jim
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PGduane
Regular Member
Joined : Aug 2018
Posts : 50
Posted 1/29/2019 10:39 AM (GMT -8)
All - Many thanks for the insightful perspective. All of it is very helpful and I'm most grateful.

As we all know, it's no easy feat to learn everything useful about this disease. Will take this all on-board and keep you all posted.

In the meantime, remaining grateful for the <0.05. Also, working to find the right balance of a) not overlooking important info for my treatment with b) leading my life and not thinking about PCa all the time.
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Wings of Eagles
Veteran Member
Joined : May 2013
Posts : 1227
Posted 1/29/2019 11:43 AM (GMT -8)
PGduane, You have already received some good advice, not sure I can add, not an expert here. But I go by the ol saying #1-"Don't sweat the small things" and #2 "most everything is a small thing" ,especailly that <0.05 PSA. If that is
what the undetectable limit at the Labs at Stanford and MSKCC use, and you are there, that's even greater for ya. Celebrate. You just posted a great outlook on things so far.
I was very happy with an undetectable of <0.06, and then my CTCA comes out with an ultra sensitive test, now it is <0.015. So like Halbert, in jest we see that as now somehow, "more undetectable" , or even "less than undetectable".Lol. I wish. But for sure, don't get hung up on this or that number, just know that the Zytiga is clobbering the beast for now. Continued success, and I like to say keep the faith!.
Wings aka Dan in So Cal
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ChrisR
Veteran Member
Joined : Apr 2008
Posts : 849
Posted 1/31/2019 5:37 AM (GMT -8)
How do you know your not <0.01....you are <0.05....if 0.05 is your labs limit then you could also be <0.01.

I have always been <0.03....that is as low as my lab goes..
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Blackjack
Veteran Member
Joined : Sep 2017
Posts : 805
Posted 1/31/2019 7:47 AM (GMT -8)
JNF pretty much nailed it for you, Duane. The ultra-sensitive IS valuable for men is different situations than you. At this point in your journey, the difference between 0.03 and 0.05 means absolutely nothing. Stick with what your doctor recommends, and keep going to the same lab.
Good luck!
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Purgatory
Elite Member
Joined : Oct 2008
Posts : 25448
Posted 1/31/2019 3:01 PM (GMT -8)
Why? What would be the point or use? Never been into ultra sensitive testing, all I have ever seen it do here, is to create or increase PSA anxiety, and in most cases, has no real use even with future treatment (if needed).
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oldbeek
Regular Member
Joined : Sep 2017
Posts : 410
Posted 1/31/2019 8:31 PM (GMT -8)

alephnull said...
IMNSHO
You are fine, as treatment won't restart/start until PSA reaches a much higher level.

For the first two years I was being tested where undetectable was <0.1 ,
then I asked for a greater sensitivity and I immediately saw my PSA hovering just below 0.1 at 0.08.
Made my life more stressful.
No new treatment, just watch the ball bounce incessantly.


My first test had a floor limit of <.1. My URO was happy with that. I went to a lab that had a floor of <.05. First result was .05. 6 months later .08. In my case, I want to see if there is a rising trend so I can think about treatment if it rises above .1
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