On your questioning why not use the best uPSA testing available, yes, I agree with you emphatically.
Can’t imagine making a case for “it doesn’t matter”.
My uro, who did my RALP seven years ago and whom I still see, and I disagree on the value of his standard test (rounds up or down to nearest .1) vs. my self Labcorp uPSA.
Did you ever see the movie "Hombre", based on an Elmore Leonard book same name? He wrote other good books, like "Rum Punch", which was adapted into the Quentin Tarantino movie "Jackie Brown". Both very tightly written script
s. Anyway, in "Hombre", Paul Newman is an Apache former lawman accompanying (just as a rider) a stagecoach on which a corrupt banker (carrying a stash of stolen cash) and his wife are riding. The bad guys capture the wife, wanting the money in exchange. Newman refuses them, despite the bad guys pressing him on what the other stagecoach riders feel:
01:15:34 - How about
the others? What do they say?
01:15:38 - They say what they want. I say what I want.
Not that my uro is a bad guy. But he does his test, and I do mine. Here is an example of what could happen with his test. A guy has true .051 uPSA, six months later it's .100, six months later it's .149. All the uro would see from his test is ".1", ".1" and ".1". So over that twelve months, he could say "gee, it looks stable, don't worry". But you know with that trend the next test would probably show ".2". And that's the accepted BCR.
A couple years ago, when I first started reporting to him that I was just starting to see values show on my Labcorp uPSA (test low limit .015), he questioned my use of uPSA, saying, "To what end -- what will you do with that extra information -- those extra decimals?" Kinda see his logic, as it would be good to know from a scan where SRT, if chosen, would be directed, and higher PSAs are needed for those scans to show true positives. Is it in prostate bed? Is it in a lymph node now?
BUT -- the uPSA has allowed me to see a trend developing, feel sure it's not just benign tissue acting up, start researching things to help me decide when I will start the next step, locate a good institution (I'm in mid sized city and will need to go outside for best SRT care). It has also allowed me a window to start some trials of diet changes to see if I can forestall SRT by slowing doubling time, as user "Cashless" is doing. Also allowed me to try going off the T cyp injections as a trial.
Last Dec., I was about
.051, and it showed up on his test as ".1" -- for first time in seven years -- always "< .1" before. I stopped my TRT injections shortly after -- my decision, he did not say to go one way or other. My uPSA dropped by 30% for four months straight, then has come up a little, but is still .030s, low .040s. So my six month visit with him last week showed "< .1" on his test again. I mentioned it might be good for me to see an endocrinologist, since, whether on or off TRT, my tests show my total T kinda low but in range, but my free T scraping bottom of normal range, and my estradiol way above top of Labcorp normal range. He got me a referral insurance approved same day, though I cannot get in to see endo for a few months. Will try various non-script
approaches in meantime to see if I can force the estradiol down and watch my uPSA too. The Chicago biochemist Friedman has a theory that it is not T causing prostate PCa, but the T/estradiol imbalance.
So I feel the uPSA is giving me some time to carefully consider what to do next.
In your case, AJMan, with the BNI+ and some Gleason 5 (hopefully not 5 at the BN), and with your steady trend of rising uPSA, I really believe you have chosen the right path. It does not look like just benign tissue left over from surgery.
Jan '08-'11 PSAs 2.2 2.5 2.7 2.6, DREs-
Jan '12: PSA 3.6, DRE+
Jan '12: MRI inconclusive
Feb '12: PCaDx pT2a, 4/12+ (3 @ 3+3, 1 @ 4+3); 3% tot cores; bone scan-
Apr '12: RALP; 3+4=7; pT2c pN0 pMx; 30%; 3mm r lat margin of 3+3=6 so pT2+; EPE-; PNI+; 8 LN-; SV-
TRT 03/'14- uPSAs: <.015 til 02/17; mostly .020-.030 then .048 on 12/1/18; off TRT since 12/2018 and uPSA settling in mid .030s
Post Edited (Bobbiesan) : 6/21/2019 6:56:28 PM (GMT-6)