PSA: How low is low enough?

[Oldie68]

I see a lot of posts where people seem to imply that PSA should be as close to zero as possible, e.g. < 0.1. I think normal range is 0-4 ng/mL for healthy individuals. Four years before I was diagnosed with advanced metastatic PC my PSA was 0.3, then slowly year after year climbed to 0.75 and then jumped to 255. Why isn't it enough to keep PSA < 4?

[Tall_Allen]

You are confusing several different uses of PSA. Before biopsy, A cutoff of 4.0 will miss about 15% of significant prostate cancers. In fact, there is no cutoff of PSA that detects significant prostate cancer while preventing unnecessary biopsies You can see why screening is so controversial.

If prostatectomy is successful, PSA will drop to undetectable levels.

If radiation is successful, PSA will drop below 0.5.

If chemo or hormone therapy is successful, psa will also drop two very low levels.

PSA is a much more useful biomarker after therapy then before therapy. It is only useful in relationship to your treatment history.

[Oldie68 in reply to Tall_Allen]

Thank you. This explains it well. Do you think my PCP should have ordered a biopsy when within a year my PSA jumped from 0.4 to 0.75, while for the previous two years it was around 0.3?

[Tall_Allen in reply to Oldie68]

No. That would have been uncalled for. There are no good biomarkers for your type of PCa.

[Ptripp2 in reply to Oldie68]

I think only a 4 or higher is considered out of normal range

[MrG68]

As written in the book, the Great Prostate Hoax the developers of the machine that performs the PSA test had to present it to the FDA. The transcripts of this meeting is online and available due to a freedom of information act. The book states:

It’s worth remembering that William J. Catalona, MD, the doctor who was largely responsible for setting 4 as the cutoff admitted that the number was arrived at “sort of arbitrarily.”Ablin, Richard J.; Piana, Ronald. The Great Prostate Hoax (p. 52). St. Martin's Press.

Yes, as unbelievable as is it, effectively they just made it up. There's no scientific underlying reason.

Further, it is stated that people may have a psa less than 4 and have prostate cancer whereas people around 11 may not.

IMO, generally looking at your psa in absolute terms like 4 is of limited value. This should be the same if you've went through the standard of care treatments and have a value like 0.2 etc. I think the true value of the test is more how the test changes between each reading. So basically, get an initial reading and see how it changes over a period of time.

On a related note, if you get a jump in psa, there are all kinds of reasons where the readings can differ. Different machines, different test providers, human error, sexual activity and more. Always consider not relying solely on a single test reading. I wouldn't be surprised that if you got two tests consecutively that they differ to some extent.

[j-o-h-n in reply to MrG68]

STANDING OVATION...THANK YOU.

Now for my stuff:

Would you please be kind enough to tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/19/2022 6:45 PM DST

[MrG68 in reply to j-o-h-n]

Why does that matter to you? It isn't even relevant to this discussion. Feel free to fact check and correct me on any posts I do or will do. It's my personal preference to not to give that information out. I've seen comments in previous posts where people have used that information as part of their arguments. I'm not interested in any of that, just the researched facts. So, sorry but no.

[j-o-h-n in reply to MrG68]

Thank you for your response. But all that information is voluntary. Keep posting we need members like you.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/19/2022 7:14 PM DST

[Hidden in reply to j-o-h-n]

❤️👍

[j-o-h-n in reply to Hidden]

We need members like you too.............

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/24/2022 2:25 PM DST

[Hidden in reply to j-o-h-n]

Members shit! You are my dude! ❤️🙏

[j-o-h-n in reply to Hidden]

I stand corrected......... member = DUDE

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/24/2022 10:45 PM DST

[Hidden in reply to j-o-h-n]

No corrections for you . Only love ❤️You’re always right in my books of humans . 🏜

[j-o-h-n in reply to Hidden]

As the democratic ad re-buked Barry Goldwater's republic ad for president in 1964 which he said he was "RIGHT".... the democrat's replied 'YES, FAR RIGHT' ...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/26/2022 4:54 PM DST

[Hidden in reply to j-o-h-n]

I was 3 . Barry was an icon in Az politics .

[j-o-h-n in reply to Hidden]

I was 4................ Yep Barry was known as AUH2O in them there parts....Aridzone-a...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/26/2022 7:10 PM DST

[Hidden in reply to j-o-h-n]

Yippie-Ki-yay ! 🏜

[j-o-h-n in reply to Hidden]

Die Hard: Yippee Ki Yay💦💦💦

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/27/2022 7:31 PM DST

[Hidden in reply to j-o-h-n]

That damed Clause ! 😳

[j-o-h-n in reply to Hidden]

You mean the Sanity Claus due on 12/25?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/27/2022 10:20 PM DST

[Steve507]

I always have noted the company's Assay (test) and generation of that test. Had Very reliable results across different company's tests done at the same time: Siemens amd Roche. There's also calibration issues. Huge topic really.

[dadzone43]

People get fixated on a number. Much more important is the trend.

[Don_1213]

I know I mentioned it before - I had two blood draws taken the same day, both sent for PSA tests (different MD's - usually Quest just does one and distributes it to both MD's)..

Same day, same blood, same machine, same MD supervising it, and I'd assume the same tech doing it. One was 0.17 the other was 0.23. That's a significant difference.

You can't count on PSA numbers alone, and getting upset by differences of 0.05 really isn't worth doing.

[MrG68 in reply to Don_1213]

Exactly! Bang on the money sir. This test should not be taken as gospel and in absolute terms. It needs to be used relatively, IMO.

[NecessarilySo]

My take is that if a microscopic piece of cancerous cells gets into the bloodstream, during surgery for example, it can take a few years to deposit in a lymph node or wherever, and then it grows at a parabolic rate, does not die, and ultimately leads to a tumor or several ,and high PSA.

[pakb]

Agree with those above. My husband was diagnosed Aug 2017 with metastatic (local lymph, pelvic bone, hip, and spine) and PSA over 677. Gleason 9. He's never had a PSA lower than 2. That was his lowest- just got that in Feb 2022. I used to worry reading all the posts about PSAs getting near zero fast. But my husband is doing well 5 years later even though he has not had a rapidly dropping PSA. We watch the trend of PSA and he has yearly scans. Scans showed no active cancer Dec of 2020. Dec 2021 his spine met glowed a bit bright so they did spot radiation to it- we get new scans next week. But PSA number trending down is what we look for- not a specific number.

[Oldie68]

Thank you for sharing. This is very encouraging. Hopefully your husband will continue to do well for years to come.