Is a January 2023 PSA Total of <0.02 (ultasensitive) to February 2023 <0.1 (Not ultrasensitive) scary? Both are quest, but ordered by different doctors. The not ultrasensitive was <0.04 in November of 2022. Panicking
Thank you
PSA Question : Is a January 2023 PSA... - Advanced Prostate...
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JWPMP
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< means "less than", so all of those reflect may the same number.
Shouldn't it read <0.04 like it did in November 2022? Could it jump from <0.02 to <0.1 in one month? If so, is that significant?
No. Less than means nothing but less than. 3 is less than 4, 3 is less than 10, 3 is less than 100, 3 is less than 10,000.
Came back <0.02 Don't understand these different tests, but guess for now I don't have to.
oh, and thank you for taking the time, truly appreciate all info you provide on this forum!
Less than 0.02 is “better” than less than 0.04. So the second ultrasensitive test was “lower”. Both of these tests were ultrasensitive.
The less than 0.1 was not an ultra sensitive test but you were still undetectable on that test, so panic is not the word I would use.
I would use the word relieved, and try to put it out of your mind until the next test (sometimes easier said than done).
JWPMP in reply to
Thank you for that.Would <0.04 to <0.1 be a "doubling" though? Both the same test. Thanks for your patience.
in reply to JWPMP
I do not believe it is the same test. One was ultrasensitive (<0.04) and the other wasnt (<0.1). In both cases it was undetected for each specific test.
JWPMP in reply to
the <0.04 was not ultrasensitive. The <0.02 was ultrasensitive. Confusing. Three doctors ordering the tests.
Thanks so much
in reply to JWPMP
.04 IS ultrasensitive.
A "not ultrasensitive test would only read <0.1
I asked my MO why not Ultra, she responded with, I won't do ultra anxiousness tests!! As long as its under 0.1 and a clean PSMA PET, then its not with losing sleep over.
JWPMP in reply to
Is there a third type? Here are two tests from last year, same day. Thanks so much
test results
JWPMP in reply to
And by the way, thank you for sharing your experience with me!
JWPMP in reply to
I posted two test results below. Are there two different levels of ultrasensitive tests? Thank you so much for your time.
in reply to JWPMP
It depends on which machine they run the sample through. Generally speaking an ultrsensitive test has limits with at least 2 decimal points (<0.04, <0.02 , <0.008 etc…), regular psa tests have limits to the first decimal place (<0.1, <0.2 etc…)
You did not double. Psa simply has not yet been detected under 3 different tests with 3 different minimums.
JWPMP in reply to
Wow...Well thank you for clarifying!
His UCSF doctors didn't get the February PSA as it was ordered by his PCP who does everything on paper still. So I wasn't able to ask them (and I didn't see the <.1 until our visit today). The last UCSF saw was the January <0.02. March he didn't get one at all. So tomorrow's test should clear things up. So confusing, thanks for your help.
JWPMP in reply to
Looks like your correct. Came back <0.02Thinking time to pick one test and stick with it.
in reply to JWPMP
I had a similar minor uptick in psa while using the 3 digit test many years ago . I found the sensitive test drove numbers anxiety . After that I’ve been on the reg test . Psa<.1 for years and this good is enough info for me and my mo. I think you are fine now . Stay the course ! 💪🏼
JWPMP in reply to
Thank you for that. His next blood test is tomorrow and is ultrasensitive. My anxiety is over the top and it's ridiculous. Appreciate the voice of reason.
in reply to JWPMP
Although psa testing is an anxiety driven event when it upticks it’s essential for us to be in the know . Conquering anxiety is a major hurdle with apc .You’re not alone in this either . I think almost everyone overloads until in a clear status . Even then , there are no givens in this quest to survive . I felt the same as he and you at the time . Please let us know the new results . I’m positive thinking for you both .. Best of luck . Stay up and positive ..
in reply to JWPMP
I am lucky due to my better half being the calm cool and collected one . In My first two years I had enough anxiety to sink a battle . She evened me out with much effort and love . I still have my days . ✌️🌵
JWPMP in reply to
Unfortunately I'm the worrier and my husband is calm about it. I do not tell him of my anxiety ever, I let it out on this forum and am grateful for patient and kind responses I get. He always tells me I'm "tough under fire" through this whole thing LOL . . . my job is to "worry", his job is to have no stress so that's my goal haha
As a wife and I cancer survivor myself, I've learned that worrying did me more harm than good. Please try to look after yourself too.
Thank you! Wow, you're dealing with a lot. Appreciate you for sharing with me...true words.
in reply to tn12
❤️👏🏼👏🏼👏🏼
in reply to JWPMP
You are much tuffer than you know . Yin and yang work together . Without her..there would be no me ..❤️❤️❤️🙏🏼
Even if the same test that is not doubling. If 0.8 then 1.6 in a month then ask questions if your MO.
Absolutely no reason to panic in the least. I had my RP about five years ago, hence, have had many uPSA tests. As long as you have the "<" sign preceeding the number, you and the hubbie are golden. You should always be crystal clear that you want the uPSA test. I've always used the same Dr. and the same lab and have had results of <.04, <.03. <.02, <.014 and most recently <.006. I've spent hours talking with techs. at Quest and even within Quest, different labs can read down to different levels. Just keep that < sign.
I am down to 0.1 - and consider all variations below this to be insignificant. I dont think they will affect the treatment options unless they start to rise over 0.2 - so why worry.
it’s nothing. Numbers that low are meaningless. Live well and prosper!
The only safe conclusion from your post is that the three reports originate from 3 different analyzers, hence, you are trying to compare apples with oranges against bananas.
I had my PSA ‘jump’ from 0.04 to 0.1. The latter at a non-sensitive lab. I queried it with my doctors who didn’t understand the significance of the < sign. I got retested at an ultra sensitive lab and it was 0.05. A slight increase but not overly worried. Along the way someone missed off the < sign with the 0.1 result. Apparently this can happen. Glad your PSA is looking fine as well JWPMP.
No one missed off anything! It is the "quantization", more popularly known as the "rounding" error. Any value from 0.0501 to 0.1499 when (4/5) rounded to a single decimal place will be denoted by 0.1. Truncation is a different thing: 0.0001 to 0.0999 will give 0.0 while 0.1001 to 0.1999 will lead to 0.1. Either way, the essence is that when valid digits are thrown away the same applies to the information they convey. And just like energy, information can't be created out of nothing.
Thanks for that experience. He has all his done at Quest, but different doctors order them. His UCSF RO, MO, and then this February one was his PCP locally. He goes to the same Quest location, but they even seem to get confused with all the orders. Today he had it drawn and there were only orders from one doctor, so going forward hopefully less confusion. I thought since it was always Quest the tests would be consistent.
Check to see if they changed the parameters of the test, in other words what the lowest threshold is. Labcorp has done this a couple of times in my area over the past few years.
Ed
I always start with that I am not a doctor, but have been in this journey with my parents for 16 years. And, my father has seen many different types of doctors and used many methods of intervention, from holistic, to oncologists, to THC. And, recently to hypnotherapy.
What I HAVE learned along the way is DON'T PANIC.
I believe that those numbers are nothing to panic about, and relatively mean the same.
Also, that even though my dad is considered advanced, and the cancer is in his bones, with two spots on his spine and hip - he is 87...
His oncologist told him that "on the ladder of what's available and what's next - he is on ladder step number ONE, of ten....ten being the worst."
Here are a few thoughts.
He looks forward to each next day, and rarely says the word cancer. He does not talk about it, or complain. However, he does have bouts of nausea and vomits on occasion - usually upon waking each day.
BUT
he focuses on, and has PURPOSE in his life. Some days when he is tired, he builds lego corvettes. He naps daily, and then either washes the car, or draws.
He's a "not retired' architect, as he just got hired as a consultant on a job to renovate a major mall that he designed 25 years ago....the project will take 2 years.
He is open to new ideas and methods of feeling better. From radiation, to THC/CBD gummies, to greens smoothies, to acupuncture, to Tylenol.
Today is is going golfing for the first time in over a year. Been in too much pain, and too weak.
But with sunny days finally in Michigan, a gummy, and patient friends....I pray that he has an amazing day outside, doing something he loves.
I PRAY that all of you patients, and caregivers TRY as hard as possible to not panic.
As my father's holistic doctor told my parents 6 months ago - "continuous stress will be much more harmful to your brain, life and body than your cancer will".
There are too many options, too many miracles, and simply just hope that each next day is better.
Sent with love,
Dawn
You sound like an Amazing coach!!Thank you, I'm writing some of these thoughts down 🥲
Jim has been getting excited lately about the days. The rain has stopped and we are able to work with our horses again which brings him the greatest joy.
He works on his total gym daily and has written goals. He is in amazing shape and feels great.
I lost my dad to brain cancer. He stayed so positive to the end.
My 82 year old mom has been battling triple negative breast cancer for 4 years and she's been struggling, so trying to keep her focused on the positive as right now she has Ned.
Jim's father who lived on our property for 17 years passed away a year ago, and he was always a dark cloud, very exhausting.
And my Uncle was just diagnosed with metastatic bone cancer and he is not a worrier and I can take a lesson from him also.
Stress is definitely the larger enemy and I will certainly put forth more effort to keep my thoughts on the right track. Too much good going on to continually worry and miss it all.
Thank you so very much for sharing you and your father's story! So inspiring and hope filled.
in reply to JWPMP
I’m sorry . That is so much that your family and you have suffered. My mom just passed at nearly 95 . She kinda went senile and angry when I got dxed. I watched over her for 20 yrs after dad passed . I know how it is to care for the aging . It is not easy . Keep strong yourself . I’m proud of anyone that cares for those suffering. Good karma , Gods blessings to you 🙏🏼❤️🕊🕊🕊
JWPMP in reply to
Thank you! My Mother in Law was here for 10 years. She died in the yard. Jim gave her CPR until the paramedics got here. Too late. He's such a strong man. Prayers and strength to everyone dealing with the storms...and thankful for the sunny days in between.
I have my crying "seconds" when he can't eat, and looks thin and aged for how STRONG mentally he is. He is inspiring to SO many , and that is what I love to share. Blessings to you and your Jim. My dad's name is Jim as well xo
Prayers and positive energy to you and your Dad...thanks so much for the inspiration
Just FYI it came back <0.02 Good lesson here for "not panicking"
Of course even if it moved up, panic would have done no good.
Note to self.
Thank you again Dawn, and blessings on you and your Dad Jim.
in reply to dadsdrdawn
16 years is something special here . I applaud you and the effort and love to keep him here . Well done! ❤️👏🏼👏🏼👏🏼
I see in your bio section that a value of < 0.04 was repeatedly obtained. The < indicates that the low limit of the method used is 0.04. Anything less than 0.04 cannot be given a number. Therefore the number < 0.1 makes no sense to me, it should be recorded as 0.1, since anything greater than 0.04 can presumably be measured accurately. It might help to inquire about whether the same method or machine etc. was used.
No difference at all. Pay the extra $$ for the ultra-sensitive test. The < indicated that is as low as that test goes. So both are as low as they go. Never do the regular test at Quest.
Thank you! Quest has done all of Jim's tests including the regular one. I know there is regular and ultrasensitive, but seems there may be a third type? Anyway, blood draw today is supposed to be ultrasensitive so we'll see in a couple days.
I think they may call it PSA-post prostatectomy. That is the ultrasensitive one.
Okay, thank you. Jim still has his prostate so maybe not one of his tests I guess. He did have HDR Brachytherapy to his prostate October 2021.Thanks again!
So it came back <0.02 and you are correct in what it's called. I hadn't seen that prior...thank you
This thread is very interesting. Makes me realize that I know nothing about interpreting the changes in PSA values. Using the following: ncbi.nlm.nih.gov/pmc/articl...
It appears that a value <.05 is undetectable and greater than .2 for two consecutive months indicates recurrence.
Are these two values the indicators that we should be using?
I am unsure and it's all over my head.The only thing I know, is when Jim's UCSF MO considered a "vacation " for Jim, her trigger for restarting scans/treatment was going to be 0.2
The decision was to stay the course for now, no treatment break.
in reply to JWPMP
I agree with the decision . Vacations don’t always work out . UCSF is great . My bud got treated there 2 yrs back . Then he moved to Mexico and is doing well . ❤️.
JWPMP in reply to
Great story! It's a couple hour drive for us, but well worth it. Prostate Cancer treatment in our area is in the dark ages. Jim's doctor has prostate cancer and is still seeing a urologist. He never heard of Zytiga, PSMA/PET scan, and he thinks Jim's. "undetectable " PSA means he's cured. And several people we know have similar stories. So thankful for UCSF.
in the first test after salvage radiation and coming off ADT my husband had a <.1 result. Previous tests had been ultrasensitive with a lower limit of .02. Salvage treatment had been decided on based on rapid rise from .02 to .09 following prostatectomy. When we saw the RO he expressed annoyance, saying the lab had changed tests without consulting with him and this was useless information to him since his treatment decisions required the ultra sensitive test in this situation. He had already talked to the lab, reordered the test with the proper ultra sensitive version, and the results came back <.02 or the level considered undetectable on this test. As other people have said, a result that is reported as <.1 simply can't discriminate between levels lower than that. .02 and .09 would both be reported as <.1
So confusing even for the doctors it seems. I know the Quest people have gotten confused with all the orders. Finally have it down to one set. And I think his PCP may have muddied the waters by ordering one when UCSF is already doing it.Thank you
0.02 to 0.09 are both <0.10 but NOT <0.1. Neither 0.1 is equal to 0.10 nor either of them is equal to 0.100.Rules apply for dropping decimal places.
I just had this discussion with my Kaiser MO yesterday. He said that Kaiser does not use u-psa testing because it is not FDA approved and the testing manufacturers haven't been able to dial in the accuracy of the machines with an acceptable tolerance. To that point, I have seen guys get different results between different labs and different months with u-psa.
To a few of the other points above, I can see where it may drive some psa anxiety. Not sure if I want to test the waters or not but I would love to see how close to zero the cancer can be controlled. Hmmmmm!
That's interesting! Thank you...I think it would cause "less" anxiety to stick with one test. Two different tests the same day gave two different results. Both were so low ( <0.02 & <0.04) it didn't bother me, i was excited one of them closer to 0. But when I thought the <0.04 in January and the <0.1 in February was the same test, I got scared. Anyway, thanks again
in reply to Cyclingrealtor
None of my four medical oncologist over 8 years have ever wanted the u-psa for me . I thought was cost related ?
Justfor_ in reply to
No, it comes down to evading embarrassing queries. Patients detecting a rising trend in the second decimal place anticipate that their MO will do something about it. But, the MO's cookbook has nothing for them. Consequently, if they honestly respond: "There is nothing more to be done at this point in time" they fear they lose face.
Correct! There is nothing in the cookbook for u-psa. I am sure that in the near future there will be a machine with the accuracy and reliability for u-psa to become recommended.
I did have my Kaiser urologist state he had nothing to offer me other than radiation and Lupron and couldn't refer me to MO until I had another biochemical recurrence of 2.0 (?). When I escalated the issue through executive management and got a referral, the MO said that Lupron and abiraterone were standard care for guys in my position for the last few years, we can add abiraterone with no issue. So is the issue cost for the care charged against the Urology ownership group? Or the urologist isn't up to speed with guys my age and the standard care recommended?
I'm 99% sure the less than sign ("<") means undetectable, regardless of which number is to the right of the less than sign. Undetectable is as good as it gets.
Quest Lab's results are unnecessarily confusing. I always use my hospital's lab.
Your worrying may not be as well hidden from your husband as you think. Relax and enjoy each day.
Thank you for the info!And really appreciate that insight into my anxiety and the reminder to enjoy the days. I sure hope it's not seeping through, and even more reason to cut it out. Now that it's finally quit raining, getting outside and working with the horses will keep us (me 😋) focused on the good. Thank you again
Make sure you have apples to apples when you compare and double check that the assay, or test type, is ulta low...to compare an ultra low to a standard assay test does not work as the standard test only reports at tenths of a ng/ml and would not tell you below that level what the real numbers is...
But doubling time is more important than the PSA level...check this out. Rick
I feel like I'm in the middle of a Chinese fire drill?
j-o-h-n <===<<< Senior management is about to spike my spikes....
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 04/11/2023 11:00 PM DST
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