PSA lab results. How low do they go…

[Phil1097]

My MO is 1,000 miles away so I’ve been going to Labcorp for my labs for the past couple months. PSA went from .4 to <0.1. I see many people post results even lower than <0.1. Is this the lowest result that Labcorp can provide or do I have to request an ultra sensitive PSA from another lab? Just curious.

[GP24]

Just accept 0.1 ng/ml - it is low enough. An ultrasensitive test usually makes patients nervous, it will not result in any therapy.

[EdBar in reply to GP24]

An ultra sensitive test allowed me to qualify for Provenge treatment last year so that is incorrect. I don’t get nervous, I want to know so I can discuss a course forward with my doctor if needed.

Ed

[GP24 in reply to EdBar]

Ed, I doubt that the third number after the decimal point did make the difference for you.

[EdBar in reply to GP24]

I disagree, it gave me an early heads up that I was becoming castrate resistant. This allowed me to start discussions with my PCa specialist about treatment options going forward, to discuss when a PSMA scan would be appropriate etc.

Ed

[GeorgeGlass in reply to EdBar]

Ed, did you get the provenge yet? I can't recall.

[EdBar in reply to GeorgeGlass]

Yes last August/September.

[GeorgeGlass in reply to EdBar]

Had you already used and failed with 2d line AR, like xtandi, zytiga or nubeqa? did you have to take another scan to get approval (proving that it was metastasized) I just want to know what the minimum requirements are for getting approved, when I go in to try and get it approved. I wanted to do provenge before 2nd line AR ADT, but they wouldnt request it, so I started on Nubeqa two months ago.

[EdBar in reply to GeorgeGlass]

I’ve been taking Xtandi for 9 years now, I was dx Stage 4, mets in lymph nodes and throughout skeleton.

[GeorgeGlass in reply to EdBar]

OK Ed, so the psa finally started rising on ADT and Xtandi, then you used that as a catalyst/authorization to get the Provenge last year? Did you stay on the Xtandi and ADT when you did the Provenge?

[EdBar in reply to GeorgeGlass]

Yes

[anony2020 in reply to GP24]

It seems in the days of advances of ultra sensitive PSA and ADT, are we in danger of overtreatment with ADT etc, as in the old days with RP?

[GP24 in reply to anony2020]

I hope an MO will not change the treatment because of a change in the third number after the decimal point. But many MOs start with ADT when the patient is worried and asks him to "do something". The start of ADT could be postponed instead.

[anony2020 in reply to GP24]

That is exactly it. the patient is a layman. He hears the PSA should be so such under 0,1. Should the MO not try to calm down?

[GeorgeGlass in reply to GP24]

My local urologist insisted that .06 did not mean psa is rising, even though it was .03, a few months earlier. I said, I think it does mean that it's rising, because it normally goes down to .01 or .02. He disagreed loudly. Well, it turned out that I was right. It just kept going higher after that. The ultra sensitive numbers are usually accurate for a reason, and that allows a plan to be made so that you don't have to wait another 3-6 months before making a plan.

[Tall_Allen]

There's no reason to go lower if you are being treated for advanced prostate cancer.

[Phil1097 in reply to Tall_Allen]

thanks for your response. Trust me, I’m happy the number dropped as quickly as it did.

[MichaelDD in reply to Tall_Allen]

Just a note my two oncologists are in agreement that I get an ultra sensitive every 3 months.

[Tall_Allen in reply to MichaelDD]

You've had SRT and SRT already, so what would they possibly do differently with the second decimal point? I think monthly uPSA is a recipe for anxiety and nothing else.

[MichaelDD in reply to Tall_Allen]

Not to argue your point. That's not why I mention this. That's why I never speak on this forum. I have one of the best oncologists in the world and I will go with what he says. It's not monthly it's every 3 months. Mine cancer is not PSA driven so they want to see it at its lowest derivative. That's what I've been told. What they look for with me are the scans that I have to take any change those might show. Any tick that they might PSA moves then they will be on the hunt. There's no anxiety with me I take it just as if it's a regular PSA. The variables here that everybody talks about I see that every time I have it. So I can't be that way and worry about the small increase or decrease. But it's up to those two to decide what I'm supposed to do for my treatment.

[Tall_Allen in reply to MichaelDD]

That makes a lot of sense when you explain that you have a low PSA subtype - I wish more doctors used scans more often in cases like yours. I hope you do speak on the forum, explaining your atypical case. There are many with low PSA subtypes who can benefit.

Which scan does he use to monitor progression?

FYI, your profile says "blood work monthly"

[raisin123]

just as an FYI lab corp does offer ultra sensitive its just your doctor has to request it. I think it runs $100

[Phil1097]

Thanks. I will ask the doctor if he thinks I should get it.

[timotur]

If you're curious, Ultalabs offers a "post-prostatectomy" PSA test that measures down to <0.02 (two decimal points) for a little over $50 with discounts...

ultalabtests.com/test/psa-p...

[Dett]

I don’t know what lab(s) our hospital uses, if any, but the ‘normal’ ranges and degree of specificity seem to change all the time. Initially, PSA results after treatment were consistently reported as <.1, which we were fine with. Then one time PSA came back as .008. Thrilled! Then next time back to <.1. Same with testosterone. Consistently reported as < 3. Then < 10, and most recently 1. I have no idea what to make of this. Other lab results seem to follow a similar pattern, at least with respect to high and low normal ranges, which makes it hard to track changes over time. MO says she hasn’t requested any changes in lab or specificity of results. Would love to know why they are doing this.

[RMontana]

Good comment...I work outside the USA and anywhere else you get PSA tested your results are provided to 3 digits, 'thousands' of units; i.e. 0.008. In the USA I found at my cancer center they report "< 0.04 !" I do not understand why they do this...I think they are trying to prevent what they call "PSA Derangement Syndrome," but instead for a guy like me who flies into the USA with tests at 3 digits, to see a 'black hole' behind a test with 1 digit brings the syndrome on faster. So I agree and when I get back to the USA I will find a LAB that reports the PSA to 3 digits. There are some interesting nomograms and research done on uPSA or ultra low PSA as predictors for outcome but without the data they are useless...TNX

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

[EdBar]

Labcorp has an ultra sensitive test that will go to .006 before it reaches undetectable. It’s the one I prefer and was recommended by Snuffy Myers several years ago. It detected my rising PSA at its earliest stage last year and allowed me to qualify for Provenge treatment when it is the most effective - when you have a low PSA. You’ll probably need to request it from your doctor.

Ed

[dixiedad]

My urol is 35 miles away. Labcorp is 10 miles. I use them and have always been happy with their service.

[JRPnSD]

the level you have is adequate.

[SteveTheJ]

Mine has been reported as >0.06

[Phil1097]

Thanks everyone. It’s only the beginning of my journey. Surgery was last April. ADT started 6 weeks ago. Radiation next.

[anonymoose2]

I’ve learned to not sweat the small stuff.

Many on this site have seen 200 to over 1000 PSA. That’s like a 3 pound hammer on the head when you get those numbers.

Working hard for body, mind and soul mixed in with a positive attitude not taking anything for granted.

Me personally 212 PSA 3 years ago body swelling horribly from cancer in limp nodes.

Down the road undetectable for 6 months.

Going on 8 months drug vacation and holding at 0.174

For my age almost 70 I consider that excellent as does my MO.

Cheers 🍻

[Teacherdude72]

only way to know is ask your MO.

But it is low and not a worry.