Three months post RT, my RO ordered a non-ultrasensitive PSA test with a lower limit of "<.1". I see posts of folks considering an increase from .02 to .06 a PSA doubling - obviously which would not be observable with my PSA test. This makes me wonder why:
1) Is there any good reason why an ultrasensitive test may not have been ordered?
2) What test sensitivity is SOC in my situation?
3) What is the SOC definition of undetectable (vs. a test's limitation)?
4) What does SOC define as doubling - doubling at the single, 10th, 100th, 1000th digit?
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I agree with Tall_Allen. I'm content with my PSA tests, which report <0.10 as the minimum. However, this is controversial withing my Advanced PCa (Zoom) Support Group. Most of the other members argue, "Of course you should want all the information you can get." We just agree to disagree.
Both of my medical oncologists believe the ultrasensitive tests help identify biochemical recurrence sooner. They also believe that nearly every treatment works better the earlier it is given. When I elected to go through more treatments when my PSA doubled to 0.06, I found massive relief in getting back to undetectable PSA and delaying any need for ADT.
Since 3 randomized clinical trials have proven there is no benefit in being treated earlier, your MOs may have changed their minds. I know I did. Many men will never have to be treated. Just as with active surveillance for low risk PCa, it will take time for patients to get used to the fact that no treatment may be preferable.
Thanks. Perhaps I misread your earlier statement, which I thought seemed to generalize to a far wider universe of cases than the universe that appears to be covered in those studies you mention.
While there are ultra sensitive PSA tests they have very little utility, except to increase anxiety. Most hospitals consider 0.1 as being the lower limit for reliable results.
In my experiences post RP usPSA has most excellent utility and is most reliable. I have been testing at least bi-monthly for past seven years, different labs in different US states and other countries. All very reliable, precise.
I absolutely rely on ultrasensitive (us) PSA, but then I had a prostatectomy. As I understand, usPSA is generally not applicable if you still have a prostate. This is a significant clarification.
Contrary to what others have stated, usPSA absolutely has utility for those of us that had RP.
Eight years ago after my RP I came to reply on usPSA <0.010 as best indicator. I do not use the term undetectable - I believe it is dangerously misleading. Yes, generally speaking, standard US guidelines define biochemical recurrence as 0.2; some centers now use 0.10. IMO both are deadly wrong post RP.
After my RP and salvage RT, at 0.10 I had Ferrotran nanoMRI imaging and salvage lymph node surgery which confirmed cancer in my para-aortic lymph nodes. Had to be there at 0.09, 0.08, 0.07. etc.
Today, I have imaging at 0.03X. Last year had both Ga68 and Pylarify PSMA. My focus continues to be a curative outcome, and if this cannot be achieved, to delay ADT/chemo for as many years as possible. Just today my latest usPSA is 0.031, six years post salvage lymph node surgery, no ADT nor chemo.
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Is there anyone out there with stable post-radical prostatectomy non zero ultrasensitive PSA levels?
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