Post RP PSA vs uPSA test: Got through... - Advanced Prostate...

Advanced Prostate Cancer

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Post RP PSA vs uPSA test

Bcmariposa
Bcmariposa

Got through my RP July 20th very well - clear margins, clean lymph nodes, Gleason 7 with PIN. Dr said to wait three months and get a regular PSA test instead of the ultra-sensitive test because 0.2 will be the action level for further treatment and the higher sensitivity test may cause unnecessary anxiety. Should I push for the lower sensitivity test?

10 Replies
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A 3-month wait after RP is standard, but a 2017 paper reported that "about half of the men with a detectable PSA in the first 3 months after RP had a lower PSA level during follow-up between 3 and 6 months after RP." [1]

& those with "a shorter TTN {time to nadir} had an increased risk of BCR {biochemical recurrence}"

Also, there are other studies that found risk factors other than nadir PSA for biochemical recurrence.

Not having the most sensitive test will cause anxiety in some. It would be nice if your Dr. secretly did the other test & informed you only if the number was super-low.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/287...

Just had PSA yesterday. Have had sensitive test each time, but yesterday had different lab and less sensitive test. Not happy, with low PSA could be climbing or dropping 25-30% with no indication.. Changed meds and want closer monitoring. Last before cut in meds was still falling at 0.118 from 0.138 three months earlier. 0.1 tells me nothing except hasn't jumped drastically.

Yes, get the ultrasensitive test definitely at 3 months. it is not true that you wouldn't do anyting about it until PSA reaches 0.2. Best outcomes are from treating earlier. He is a urologist - and urologists don't treat patients who have a recurrence (radiation oncologists do), so he is not well informed.

Jimbo59
Jimbo59 in reply to Tall_Allen

Would your advise hold true for a post prostatectomy post aRT 3+4 pt3a case (with extroprostatic PNI and tertiary 5)

1st PSA test <0.01 may 2015.

All other 3 monthly checks have been (less sensitive ) <0.1 results. In UK and get free testing at this level but could afford to pay for a more sensitive test if there is any theoretical advantage to it.

Tall_Allen
Tall_Allen in reply to Jimbo59

No. After aRT there’s limited evidence that starting ADT confers much benefit before PSA reaches 0.2

I also endorse the more sensitive test. "Sensitivity" is not just a question of cutoff level, it's also a question of precision. A low sensitivity test may not tell you the difference between 0.150 and 0.249. They might, conceivably, both be reported as 0.2. But they are quite different numbers. One number is 66% higher than the other.

Another issue has to do with planning. If, at three months, your actual PSA is 0.100, then there's a good chance that your surgery failed to get all of the cancer. I can't cite a citation but I seem to recall that studies have shown that the very best chance for successful salvage radiation happens before the PSA reaches 0.2, and after 0.4 the chances of success begin to go significantly lower.

If you need salvage radiation, you won't be able to walk into a doctor's office and get it. You may not even get an appointment for a consultation for many weeks. Then you'll need insurance authorization and you'll need to work around the doctor's schedule. He may be planning a vacation in the next month or two, may have a full schedule of patients lined up, and may tell you he'll do it in 3 months. Now what? Your PSA may actually pass the 0.2 sensitivity level 10 weeks before your next scheduled PSA test and when the test finally shows that you're above 0.2, you may already be at 0.3 or even 0.4, and there's a decent chance you'll be above 0.4 by the time radiation begins.

I don't mean to alarm you about these possibilities. The odds are good that your surgery was successful or, if it's not, you'll be able to take action in some reasonable amount of time. But if there's no significant difference in cost, and even if there is, I just can't see why the PSA blood draw shouldn't be submitted to a sensitive test rather than an insensitive test.

I just don't see a good reason to get an inferior test when a superior one is available.

I know it's a pain to have to fight with doctors. You feel dependent on their good will and fear that if you challenge their expertise they might lose interest in taking care of you. So you try all kinds of friendliness and finesse while telling the guy he's wrong. In this case however, he shouldn't be the guy who gives you further treatment anyway. That should come from a radiation oncologist or a medical oncologist. So if he takes offense (which is a bad sign anyway, I don't trust doctors who take offense too easily), there may not be any serious consequences for you.

Best of luck.

Alan

I also recommend having an ultra sensitive test. I had a RP in Oct 2014 and 2.0 yrs later my PSA had risen slowly to just under 0.1, with the test result <0.1. I waited 6 months as directed by my Dr who said I was cured by the way. At 2.5 years I elected to get an ultra sensitive test and the result was 0.15. Good thing I chose the ultra sensitive test so I could move forward quickly with SRT. A couple of days prior to starting SRT my PSA was 0.185. Several studies show SRT is more effective when started prior to a 0.2 PSA reading. Almost one year out after SRT and PSA is 0.025. I now get ultra sensitive PSA tests every 3 months. Get the ultra sensitive test.

3 months (the same amount of time it takes a caterpillar to become a butterfly). Papillon.

Good Luck and Good Health.

j-o-h-n Friday 08/10/2018 4:08 PM EDT

Hola, I am following the duscussion from Mexico and this is the first time I have encountered “ultrasensitive PSA test”. Is this something new?

Year old post but I don't agree. Get a uPSA so any rise can be tracked.

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