SOC & PSA

[SCreader]

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?

[Tall_Allen]

1. Because it only creates needless anxiety and no actionable info. Those men that you see computing a PSADT based on uPSA are committing an error.

2. The lab test you got is the SOC.

3. There is only a test's limitation for what is undetectable. That is precisely what "undetectable" means.

4. There is no definition of PSADT for values <0.1. In addition, there must be at least 3 values above 0.1

[Gearhead in reply to Tall_Allen]

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.

[ron_bucher in reply to Tall_Allen]

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.

[Tall_Allen in reply to ron_bucher]

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.

[ron_bucher in reply to Tall_Allen]

Can you share the links to the trials?

[Tall_Allen in reply to ron_bucher]

Sure:

prostatecancer.news/2019/09...

Exceptions:

prostatecancer.news/2021/10...

[ron_bucher in reply to Tall_Allen]

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.

[Dr_WHO]

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.

[NanoMRI in reply to Dr_WHO]

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.

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

Welcome back Dr_WHO, were you hiding in the Witness protection program or in the Joint?

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 01/10/2024 7:36 PM EST

[SCreader]

Reading many posts here on HU, one would think you should test to .00n. Thanks everyone.

[NanoMRI]

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.

[Gearhead]

As I said in my earlier reply, this issue is controversial, and maybe we should just agree to disagree.

[PSAed]

Great questions,thanks.