Undetectable PSA?

[6357axbz]

At what level is ones PSA deemed “undetectable” and what is the significance in reaching this benchmark?

[Hidden]

Less than .01 is considered undetectable. My doctor told me at the last visit that with an undetectable PSA, you have about a 1:1000 chance of having progression.

[6357axbz in reply to Hidden]

Wow! I love those stats. I’m down from a high of over 10 in September 2018 to 0.2 as of last week due to a combination of Lupron, Zytiga/prednisone and 26 out of 30 sessions of IMRT to prostate. I have Mets to ribs and iliac. I hope I can get that low.

[Hirsch in reply to Hidden]

Short or long term progression?

[Hidden in reply to Hirsch]

No progression, he didn't specify beyond that. He also said at that level he would not be concerned about NEPC cells since they are always mixed with other cells that do produce PSA. Neuroendocrine PCa is a LOW PSA cancer, but not a NO PSA cancer.

[Tall_Allen]

Undetectable is relative to the PSA you use. On an ultrasensitive test, a PSA below 0.01 may be undetectable. On a conventional PSA test, anything below 0.1 is undetectable. The significance depends on the treatment you are having.

[Hidden in reply to Tall_Allen]

The difference between .1 and .01 is important for someone who has had RP and no recurrence, but for advanced patients, it's at the noise level.

[Tall_Allen in reply to Hidden]

I agree. In fact, I often suggest to patients that are not anticipating salvage radiation after prostatectomy that they only use the conventional PSA test. It causes needless anxiety in others. Unfortunately, many MOs seem to use uPSA routinely.

[Hidden in reply to Tall_Allen]

I think we always have to look at any test and say: how does this effect my treatment plan? Most advanced guys will be upset if their PSA goes up from <.01 to .1, but this would not result in a change of treatments. That's the most important thing.

As you said, this would apply to everyone accept those who are considering salvage radiation. With salvage radiation, A PSA of .1 to .2 gives the best chances from what I understand.

[6357axbz in reply to Hidden]

If one has had IMRT to prostate (no prostectomy) how does that factor in to how PSA is viewed?

[Hidden in reply to 6357axbz]

PSA after radiation will not be as low as after RP. Here's an article on the subject. cancer.org/cancer/prostate-...

[6357axbz in reply to Hidden]

Thanks

[epfj3333 in reply to Tall_Allen]

I don't understand why "undetectable" still has a number attached to it. Even if it's 0.01. Shouldn't it be 0.000?

[Tall_Allen in reply to epfj3333]

Undetectable means undetectable by the specific lab test they used. It is denoted by a "less than" symbol - "<"

[tango65]

It depends on the tests. With ultra sensitive test a PSA 0.03 or lower may be considered by some to be undetectable. However there is some information from JHopkins indicating that with ultrasensitive test , perhaps 0.003 shoudl be considered undetectable. These are tests that can measure at least a PSA of 0.002 or lower.

hopkinsmedicine.org/brady-u...

[Schwah]

Could you please provide a copy of that study Nal? I also recall reading that the OS is closely related to how low your PSA goes when on ADT. I can’t find that study tho.

Schwah

[Don_1213]

I believe it also relates to the treatment you received. A successful RP or RRP should result in PSa of less than 0.0# (# depends on the actual test used.) That's because the treatment should have removed all the prostrate tissue from the body, so no PSA reading.

RT will give different results. With radiation treatment there is still some prostate tissue in the body, although the hope is the cancerous tissue has been destroyed. That remaining tissue may produce a small and varying amount of PSA, until a steady state is achieved (aka nadar). That nadar can be as high as 1 or so and not be an indication of PCa. Or it can be below 0.1, when it's considered undetectable. It is not common to give men with radiation as their primary treatment ultra-sensitive testing.

[Tonik25]

We are in Australia and all tests since RP (4 of them) have come back the same <0.008 - I don’t know if the 8 is significant, I just assumed that was the lowest number the test could detect and none was detected.

[EdBar]

It is my understanding that if your number has a < in front of it that it is undetectable, meaning it is below detectable levels for the particular type of PSA test being used.

Ed

[6357axbz in reply to EdBar]

< is a math symbol that simply means “less than”, just as > means “greater than”.

[EdBar in reply to 6357axbz]

Yes I realize that...

[6357axbz in reply to EdBar]

Sorry, EdBar. I see what you mean. In that case “undetectable” would have no cancer specific implications but only refers to the limits of the particular test your using. I had hoped undetectable referred to a finite number that reflected something about the volatility of ones cancer, as in what gregg57 said above that a PSA of >.01 meant less than a 1:1000 chance of disease progression.

[EdBar in reply to 6357axbz]

My docs have told me as long as you’re < you’re good

[erjlg3]

Elgie has been 0.05 consistantly for over 2 to 3 years.

[leo2634]

0.1 going on 17 months now. Zytiga, Eligard, Xgeva for bone Mets.

[6357axbz in reply to leo2634]

Good show. Hope I’m where you are after 17

[leo2634 in reply to 6357axbz]

Also just started Provenge last week Doc says let's kick it while it's down.

[petercraig2]

My PSA is now .008 and seems steady for now and my Onc tells me PC is in remission.

However after detailed discussions on predictive indicators he gave me a script to have quarterly blood test for DHT, Chromogranin A, Alkaline Phosphatase and Alanine Aminotranferase. Current values are all low and give me a reference Baseline. If any begin to increase it is time to look at upgrade or change in therapy. While GA68 is best PET/CT scan available I/we would like to respond to changes before scans show anything.

Prophalactic measures.

Peter

[Hidden]

<0.1 or less than 0.1. This is the threshold that matters, period. Some will tell you a different number much less, however, unless they are a researcher, most do not know how to interpret the numbers. Even my research medical oncologist uses this threshold and he has been in academia for 30 years slicing and dicing mice. He feeling: ultrasensative testing serves only to confuse and worry in patients as whether one has a prostate or not, there will always be minute readings of PSA from other sources...... even women have some PSA measurement.

Gourd Dancer

[RonnyBaby]

I am 'undetectable' and have been (luckily) for 4 consecutive cycles. My next test is in 2 weeks, but I expect to keep the trend moving forward, seeing as I feel much stronger and better in the last month.

The number referred to is <0.02. (less than 0.02) I had a more accurate test done and that number was <0.002 (8 mos ago) - note the extra '0'.

Depending on the type of treatment, (radiation for example) some ROs say below 1.0 is a good outcome (nadir refers) , but the reality is when you approach / attain ZERO, you have bottomed out.

It was the ADT (16 mos) that took me there. As much as I hated the ADT side effects, I wouldn't have hit those numbers without it.

I wish you well on your journey ....

[j-o-h-n]

What Level? = When you're room temperature..

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 05/30/2019 4:16 PM DST