When I get a PSA test at Quest Diagnostics, the detect limit is 0.04, but I've noticed a lot of guys report PSAs of <0.01. Is that detect limit typical? Should I insist on a different lab?
PSA Detect Limit: When I get a PSA test... - Advanced Prostate...
PSA Detect Limit
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ElRanchoDePoisonIvy
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My work has taught me a thing or two about quality and tolerance. I am definitely skeptical of a .01 nanograms per milliliter detection level.
There is no need to do anything before PSA reaches 0.1, so why get a more sensitive test. It will only drive you crazy.
I disagree, my PSA hasn't been over .08 for many years, yet several nodes have been detected and erased with surgery or cryablation. Labcorp reports <.006 for undetectable in an "ultrasensitive PSA" test. When my PSA rises to .010 - .035, there's always a scan detectable node, which is also biopsy proven.
what scan to use when your psa is .035?how do you detect the node at this level? If you can’t detect it, you can’t biopsy it and you can’t do surgical procedures on it. Just very curious as to your approach if you don’t mind sharing please.
yes, please tell us more. Positive, biopsied, nodes with a PSA of .035 or less? Never heard of that. This must be cutting edge.
Simple, scan shows a node or two in the same area, biopsy, Biopsy positive then ablate it. Earlier this year I had a .8 cm node in my neck and PSA went to .026, I felt the node as well. This happened within 3 months. PSA every 4 weeks, heads up it actually went to .006 (not <.006), then .011, then .026. Alternate between PSMA and FDG, every 3 months, PSMA doesn't show much, FDG better detail. Radiologists look at a prior scan (3 months prior) and know something is new. Nodes inside your chest need an interventional radiologist to biopsy. It takes a lot of effort on my part. Not really cutting edge, just being on top of it with existing technology.
Nothing more for me to write on this subject, you get the picture.
Rarely, patients have a type of prostate cancer that doesn't express PSA. You just demonstrated that even in your case, a more sensitive PSA test is useless. In an usual cases like yours, only scans are useful. I suggest you get periodic scans no matter what your PSA is.
I disagree. Ultrasensitive PSA can be very useful after a prostatectomy. After surgery, my PSA started to slowly rise. The SOC says when it reaches 0.2, it is time for radiation, etc. With regular PSA testing, I would see over time <0.1, then 0.1, and then 0.2. With Ultrasensitive PSA, we get one more decimal point and more information as it rises. For example, over time it would be <0.01, then 0.01, etc. and eventually 0.10, then 0.11, 0.12, etc. With regular PSA tests, when you reach detectable 0.1, it could actually be around 0.08 all the way up to 0.15 at the first detectable blood test. It hits you all at once, and the decision to do salvage radiation must be made with little warning. With ultrasensitive PSA, I have a better view of what may be coming, giving me more time to research what and when to do further treatment. I decided to do something BEFORE reaching 0.2, with the hope of a better outcome, which would be more difficult with only one decimal point regular PSA tests. I know that calculating doubling time with very low PSA values is not recommended, but I can get at least some idea of my doubling time, which is very helpful for diagnosing low vs high risk cancer. In my case, PSA increased very slowly over several years, which I could not have seen with regular testing. I vote strongly for ultrasensitive PSA testing after a prostatectomy.
You can have any personal opinion you want, but medical science dictates why 0.1 is now the standard. It is based on clinical trials showing that there is no advantage (except in a few special cases) for treating with salvage radiation at lower PSA. Here are the data, proved in 3 different large clinical trials, which is irrefutable and constitutes the current standard of care.
prostatecancer.news/2019/09...
With conventional PSA tests every 3 months for the first year, every 6 months for a couple of years, and annually thereafter, any patient will have plenty of time to get early salvage radiation.
Everything is refutable. As I point out for myself going over .006 is meaningful, my calculus means that .1 would represent 6-10 nodules. Don't ever want to get there.
JACK71, I'm not sure who you are disagreeing with, but it's not me. The evidence is there that uPSA testing is useful for planning for when you can take action (or if you need to ) Watching progression and timing from something like .04 to .08 can be valuable for planning. Also, consider the scenario of consistent .08s, that round to 0, and then all .09s that round up to .1 in a less sensitive test. The thing I haven't seen conclusive evidence for is any importance of micro sensitivity at or below .03 or so. Here moving around from .007 to .010 has not been demonstrated to help predict anything. At these levels, you are now tracking extra prostate PSA along with other noise factors. Has this changed? Does anyone have any other or new info on that?
I totally agree with you jimbay! Your example with regular PSA rounding is probably clearer to most folks than mine. There is useful information with ultrasensitive PSA that you won't know about with a standard test that rounds up or down and has only one digit of data. I'm not challenging the standard of care for additional treatment. I do want that additional information that helps me decide when I've reached that treatment level, and that gives me some information on what my PSA trend is (up or down) before my PSA suddenly jumps from 0 to 0.1.
Thanks for noting that. I would correct what you wrote and say that an ultra sensitive PSA is very useful when a scan is done, if you have been at <.006 and are suddenly measuring some PSA, something is making that PSA.
If a nodule is in my neck I can feel it. I get very regular scans. I have a simple calculus, a 1 cm nodule will raise PSA .01 - .02, I had 4 lung nodules 18 months ago, PSA rose to .08. So when PSA rises above .006 (Labcorp undetect.) there's a nodule somewhere and the scan will find it, FDG seems to be better at that precision, provided there are a sequence of pictures to compare. I alternate PSMA with FDG. All my nodules (about 12 in the last 7 years) have been in my upper torso and neck in soft tissue. Whack-a-mole. There's a new term MDT ?? metastatic disease Tx ??, new term for oligometastic Tx ??
But since there is no known benefit to playing whack-a-mole (the technical term would be SBRT to metachronous oligometastases) what is the point?
My last test came back as <0.0 My MO called that undetectable and was very happy with it. I have no idea if there more digits and have been told here to not worry about it, good with my!
I just spoke with my Oncologist about this. She advised different labs have different minimums. My last report went from .00 undetectable, to .04. It does not mean you are a .04, it means that is the minimum that lab reports, some report .01. Most likely you are a .00. Merry Christmas
Either of their ultra sensitive tests report to 0.006.
Quest uses a different testing method that isn't compatible with just about any test you get elsewhere. So if you go to anywhere else the actual measurement will be different. This might concern or confuse you This isn't how low they measure, which can be different depending on the test and lab. But a actual different real number.
Your better off sticking with LabCorp to get a compatible number.
So if you went on the same day to Quest and LabCorp you'd get two completely different numbers. The LabCorp number would be compatible anywhere else, but Quest wouldn't be compatible.
The "old fashioned" tests that go to only 0.1 do more rounding so are less accurate to changes so they can confuse you as well.
If your PSA is up in the single numbers like 8.0 or 20.5. There is no need for the ultrasensitive tests. If your PSA is below 1.0 say 0.136 or 0.067 or 0.009. You want the ultrasensitive tests.
PSA = Permanent State of Anxiety. You are worrying about nothing until it hits 0.1.
Listen to the advice you are getting here. There is really nothing usable below .04. I get the labcorp test which currently has a .006 minimum. I recently got a .008 which analytically I know means nothing, but emotionally drives me crazy.
”uPSA ≥0.03 is an independent factor, identifies BCR more accurately than any traditional risk factors, and confers a significant lead-time advantage. uPSA enables critical decisions regarding timing and indication for post-op RT among high-risk patients following RP.”
Great rasin123, that quote looks familiar. What is the source. Could you drop a link?
Never mind I found it: ncbi.nlm.nih.gov/pmc/articl... Yes, looking at this study there is value down to .01 but not further than that. TALL_ALLEN you weighed in on this study before. What where your thoughts?
is anybody aware of a chart of post surgery or radiation PSA counts along with commentary on the interpretation of the seriousness of each count?
Here are two articles that I used for my uPSA (ultra low) which I could only get outside the USA. In the USA centers either report <0.01 of 0.04; they dont go any lower; PSA to them means 'prostate stress antigen,' so they dont want us to know below those levels what trend is developing. Yet there is good science that says its good to know what your PSA is doing a very low, ultra low, levels. If I were you I would try to find a Lab that reports to the 'thousands,' of ng/ml, i.e., 0.001 to 0.009. This data could be useful. TNX
healthunlocked.com/active-s...
It depends on the regent the lab is using. .1 is what is reported in some places. Others use a more sensitive regent and get .04, but they may both be reflecting the same PSA.
Siemens Total PSA(TPSA)chemiluminescent(LOCI)immunoassay
Does anyone know what level is considered undetectable for this test?
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