Thoughts about uPSA nadir of < 0.008 following RP to independently predict BCR risk?

[jronne]

ncbi.nlm.nih.gov/pmc/articl...

"In the multivariate analysis, statistically significant differences were observed only in pathological nodel stage within the PSA nadir <0.008 ng/ml group (P=0.0107). For this reason, postoperative follow-up using ultra-sensitive PSA is considered to be of value, since the use of high-sensitivity PSA to confirm a reduction to below postoperative measurement threshold value (PSA nadir <0.008 ng/ml) may avert administering unnecessary additional treatment, regardless of pathological reccurrence factors."

60 years old

Decipher score 0.22 low risk

11/15 RP UCSF Dr. Carroll

pT2a pN0, invasion into capsule, EPE-, LVI-, PNI+

3+4 Gleason7 30% 4

10% tumor 1.2 cc

PSA 5.0 9/28/2015 (free PSA 8%)

12/27/19 12/20/19 12/13/19

0.011 0.010 0.012

7/19 4/19 11/18 9/18

<0.006 0.008 0.009 0.007

7/18 4/18 2/18 1/18 11/17

0.007 <0.006 <0.006 0.008 <0.006

[Tall_Allen]

You keep posting the same thing. I guess you don't want to take yes for an answer.

[jronne in reply to Tall_Allen]

This study used uPSA values for the first years at a very low uPSA level less than 0.008 but as far as I can tell only looked at BCR roughly 5 years post RP which is not as useful as the UCLA study in terms of long range predictions as that study was closer to 10 years post RP. It is more useful as it deals with low uPSA levels. It would be nice to known if one has a uPSA nadir of less than 0.008 what are the odds of BCR in 10 years or 15 years. The UCLA study only deals with passing the 0.03 at any future point in time which is pretty useless for guys with lower slower rising uPSA levels in terms of risk prediction as it is incapable of estimating the future BCR risk for instance of someone that has current uPSA level of 0.012

[Karmaji in reply to Tall_Allen]

Dear TA

In France...all labs give low PSA level as 《 0.05...

They say below this gives no meaningful information.

Even Uro RO and onco say the same.

Any opinion....on this

Thanks

[Tall_Allen in reply to Karmaji]

Since RADICALS, we now know that treatment when PSA reaches 0.1 or 3 consecutive rises is equivalent to earlier treatment. Earlier studies have shown that no PSA below 0.03 is predictive of BCR. So there is now level 1 evidence that a pattern of say, 0.03 ->0.04 ->0.05 ->0.06 should be treated. You would not know this without uPSA below 0.05.

pcnrv.blogspot.com/2019/09/...

[Gemlin_ in reply to Tall_Allen]

Same reasoning in Sweden (as in France). They report all test results 0.099 and lower as <0.1. The machines they use measure much lower! No one is treated below 0.1 so why add to the anxiety we patients already have?

[Tall_Allen in reply to Gemlin_]

see above

[Gemlin_ in reply to Tall_Allen]

As you wrote in the blog "Patients in all three trials had positive surgical margins, extracapsular extension, or penetration into the seminal vesicles." i.e. those with "bad" pathology benefit the most from the 0.05 report interval.

Patients with "good" pathology could "safely" wait with SRT until 0.2 (or higher if PSA-DT is very long and expected remaining life limited) and a 0.1 test is sufficient.

We should limit PSA anxiety if it will not jeopardize possibility for cure, in a holistic patient care, or what do you believe? The original post demonstrates that PSA anxiety is real.

[Tall_Allen in reply to Gemlin_]

I share your concerns about anxiety, especially for this OP. In fact, I have often told this OP that he has nothing to worry about, yet he persists in worrying. In his case, his anxiety is his only problem.

However, setting this OP aside, I think the longer one waits, the longer the cancer has to "seed" and to prepare new "soil" for that seed. So one has to balance those concerns. The question is- how to strike that balance.

I don't agree with your assertion, and I don't know what basis you have for making the statement: "Patients with "good" pathology could "safely" wait with SRT until 0.2 (or higher if PSA-DT is very long and expected remaining life limited) and a 0.1 test is sufficient." I have seen nothing that says that. In fact, for patients with good pathology, the data I've seen argues that any any uPSA over 0.03 with growing or unstable PSA is in danger of recurrence:

pcnrv.blogspot.com/2016/08/...

But based on RADICALS, it seems clear that PSA over 0.1 or 3 consecutive increases is a minimal warning sign for any pathology (if it is enough for bad pathology, it is certainly good enough for good pathology). Until we have a randomized clinical trial for men with good pathology, it seems prudent to use the same standard for both - wouldn't you agree?

[jronne in reply to Tall_Allen]

I value your opinion, just to be clear if I have nothing to worry about then my long term risk of ever having BCR is effectively zero correct in your opinion ?

If my BCR risk is not effectively zero then I would like to quantify it if possible.

A friend sent me the study last night because he is also interested in the potential predictive power of early uPSA numbers and trends. His uPSA is measurable but low like mine.

My uPSA nadir was repeatedly below the 0.008 referenced in the study.

The study failed to address 10 and 15 year BCR outcomes

[Tall_Allen in reply to jronne]

I can only comment on NOW, not the future. My crystal ball is in the shop

[jronne in reply to Tall_Allen]

UCSF for instance told me this week to continue to test uPSA regularly as there was no certainy to the outcome. They told me I should be concerned and we will see when it plays out to BCR. They did not say that they had ANY patients with low uPSA values that stayed low indefinitely for years without rising.

I do not want to rely on a crystal ball and pointless hope if it can be avoided. I find facts and hard data to be far more assuring.

So the question remains unasnwered if ANY patients anywhere with low uPSA values that stayed low indefinitely for years without rising.

Lots of talk not no responses to the question.

I just want to some hard data with BCR or not BCR outcomes that applies to guys with low uPSA values near 0.01. I realize these may have larger margins of error but everything in life is never an absolute certainty.

I have nothing to worry about now but all the guys I have interacted with prior low uPSA levels on several forums have all without exception eventually trended upwards and onwards towards BCR. I would love to hear of JUST one counterexample.

There are no studies that I am aware of that document low sustained uPSA levels.

The question is likely not IF BCR happens when does it happen for me.

I have yet too hear of one guy or one guy that knows a guy that has low stable uPSA values indefinitely.

[Gemlin_ in reply to Tall_Allen]

Allen, My only "basis" for my "statement" is from a mail conversation I had with Equalis (an EQA provider in Sweden which provide external quality assessment schemes in laboratory medicine, diagnostic imaging, and point-of-care testing to participants in Sweden and the other Nordic countries). Those people recommended the 0.1 as lower limit for PSA reporting in Sweden and I asked why. (I actually questioned the recommendation which the labs follows since 2016, it was 0.05 before.)

They referred me to the Swedish "prostate cancer care program" which writes (google translate)

At high risk of local recurrence (cancer of the resection border), radiation therapy should be initiated in the case of rising PSA in the range 0.1–0.2 μg / l. PSA values ​​≤ 0.09 μg / L are often residual benign prostatic tissue. These values ​​should therefore be stated as <0.1 μg / l in the response from the laboratory, as the clinical benefit of knowing these low values ​​is insignificant and is not considered to offset the concern that it may cause to give variable PSA values ​​for the patient.

I could continue my mail conversation with a link to your blog to tell them that their conclusion can be questioned. Probably not possible for a patient to change national care programs. Could that happen in US? What is the AUA guideline?

[Tall_Allen in reply to Gemlin_]

The AUA and ASCO still recommends possible adjuvant RT with adverse pathology:

ascopubs.org/doi/full/10.12...

However, I think they will change their recommendation this year based on RADICALS