Is it reasonable to pursue ultrasensi... - Advanced Prostate...

Advanced Prostate Cancer

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Is it reasonable to pursue ultrasensitive PSA test that is more precise than undetectable at <0.05?

PGDuan
PGDuan

Hi, My latest PSA test was "undetectable at <0.05"? Is it reasonable to insist on a more precise result to better gauge my risk and prognosis? My MO at Stanford said this is their standard ultra sensitive test and I should continue it at their lab.

I've noticed many of you reference scores between 0.05 and 0.01 hence I'm wondering where I am in that spectrum.

A more precise score probably wouldn't change my immediate treatment plans (EBRT + 12-18 months of ADT+Zytiga), but I've seen some studies that show better odds based on nadir so I assume a <0.01 is better than a <0.05.

Thanks in advance for any insights.

Here's my story....

6/18 - 52 at diagnosis. Dx with PSA 10.8. GS 4+3.

8/18 - RALP@Stanford. -margins,-nodes(0/15), -bone, -Ga68 PSMA/PET scan. PT2NoMo.

9/18 - PSA 4.0!

11/18 - PSA 4.5!!

11/18 - Axumin & 2nd review of original PSMA 68Ga scan id 2 suspect pelvic nodes. Started Lupron.

12/18 - PSA 0.37. Started Zytiga+Prednisone. Started EBRT (35 fractions, 70 & 50 gr.)

1/19 - PSA <0.05

19 Replies
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I don't think ultra sensitive is necessary since the threshold for a treatment decision/change is well above the level you are at now. All it will do is give you more Prostate Specific Anxiety which you don't need.

That's my opinion, not a doctor's so you could discuss it with your doctor.

Ultrasensitive PSAs are useless for you now. PSA will hopefully remain below 0.2. It will only cause anxiety to watch the extra decimal points and will make no difference in wen or what you do for your next treatment.

PGDuan
PGDuan in reply to Tall_Allen

Thank you! I trust my MO and figured there was a good reason, but with this crazy disease I wanted to be sure I wasn’t missing something helpful.

Break60
Break60 in reply to Tall_Allen

TA

For whom is uPSA useful?

Bob

Tall_Allen
Tall_Allen in reply to Break60

Only after prostatectomy and before any salvage therapy.

You are fine, I consider your test to be pretty Ultra Sensitive. Mine goes to <0.03, depends on the analyzer. Different manufacturers.

There was one recent serious paper I reported on a few weeks ago, not as a Post but as a response to a similar question you have. It used the same test I use, that goes to <0.03. In the paper, using 30 day PSA's that those men who at some point went from <0.03 to 0.03 to then 0,04----> 3 months in a row, were strong candidates for Bio-Chemical Recurrence. As this was predictive and measured from results which are all considered to be undetectable, which makes this very interesting. As many consider less than 0.1 to be undetectable.

So this paper suggested that this was a predictive outcome, even though a BCR, may not occur for a long time. Take what you want from it.

Nalakrats

Don_T
Don_T in reply to Nalakrats

Nalakrats:

Have you seen this one?:

ncbi.nlm.nih.gov/pubmed/110...

Nalakrats
Nalakrats in reply to Don_T

No, but kind of adds to the paper I have seen about the 3 rises in 3 months of 0.01/per month. Thanks for the find.

Nalakrats

Good morning PGD 🌞I agree with Gregg and Tall. Why stress out when it’s that low? On 12/31/18 my PSA went up slightly from undetectable (<0.01) to 0.12. I’ll go back to the Mayo in Jax on 2/5 for an update on it, Guardant genomic testing, and a PET scan to see if there’s any new bone tumor activity...all just precautionary. I’m not sweating it, and I refuse to allow it to drive me crazy in the meantime. I’ve already discussed it at length with my oncologist. He was very reassuring. We will deal with anything that comes up when it happens. Meanwhile, I still feel pretty good. In fact, after I finish this I’m going out to the driving range to hit a couple of buckets of golf balls. Trust your M.O. and go out and enjoy the day! 😎

Dr. Myers always recommended getting an ultra sensitive test, the one I’ve been getting from Labcorp goes as low as <0.006, fortunately that’s where I’ve been holding for quite a while now. The test doesn’t give me anxiety, and I’d rather know ASAP when things start trending upward to plot the next line of treatment.

Ed

rbtbrsrd
rbtbrsrd in reply to EdBar

All of my PSA tests have been less than, so I guess I haven't reached my Nadar yet. It has been 9.5 years.

EdBar
EdBar in reply to rbtbrsrd

Less than < just means that your PSA is less than the lowest level that particular test can measure. So it is considered undetectable by that test.

Different labs use different testing methods, some measure to a lower level than others. Labcorp ultra sensitive is the lowest I’ve come across. That’s the one I use.

Ed

rbtbrsrd
rbtbrsrd in reply to EdBar

I should have said that I have reached my Nadar but the test is not accurate enough to give me a solid value. Last PSA from Labcorp was <.006

Undetectable or <0.1 is all I need. I asked my MO ten years ago and he reply was simple, “my decisions are based on standard testing, why put you through the stress. Besides, you will always have some PSA registered, not related to your prostate cancer.”

GD

Mikes21
Mikes21 in reply to gourd_dancer

Did you have prostate removed? I have been < .006 and yesterday got a read of <.014 and this is lab corps ultra sensitive. Dr said not to worry cause still undetectable

gourd_dancer
gourd_dancer in reply to Mikes21

Mike, no, I have seeds and a short course of IMRT as primary treatment. As your MO said you are undetectable. Defined as <0.1. Note, even w/o a prostate, you will always some measurable degree of what is called prostate antigen (PSA) from other sources. My guy told me that uPSA testing serves to cause worry in patients as PSA fluctuates in minute quantities and many, even physicians, do not know how to interpret the result. So, as long as you are below 0.1, you are good to go.

No worries, enjoy life.

Gourd Dancer

With a p3b N0 MX July 2009 and a recent PSA of <.006 and no standard treatment since surgery, PSA test as far as I'm concerned is not accurate or precise enough. If I reach the PSA level of females would that be considered a near cure?

Like women, we must worry about our "."

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/29/2019 6:39 PM EST

Quest diagnostics goes down to 0.02, but with the successful Zytiga + radiation you did, I expect it will be a long time before you will need another PSA. Enjoy your remission. Enjoy life.

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