Psa is back

[Blackholes]

Well I made it to 27 months of upsa testing after my surgery and went from <0.01 to my first detectable of 0.01.

Don’t know what this means but I guess the next few upsa tests will be telling.

Maybe a lab variation maybe not.

[Still_in_shock]

Since they cant read below 0.01. what's to say <0.01 is undetectable??

Seriously do not sweat that.

[RJAMSG]

I’ve had a similar PSA result (lab error), because I rechecked it 2-weeks later and went back to <0.01 and has been since. God Bless & prayers!

[Blackholes in reply to RJAMSG]

That’s what I’m hoping for. Time will tell.

All the very best to you.

[NanoMRI in reply to RJAMSG]

Which result is right and which is 'error'? I have well over 50 tests to thousandths in past eight years, different labs in different US states and other countries. I do see and record fluctuations in thousandths, and hundredth when thousandth is 0, but have yet to see an 'error'. I focus on trend and at what value I will take next actions. As I understand hydration and Vit B supplements can slightly impact results.

[EdinBmore]

I don't think that .01 is "detectable." Many labs don't even do testing that detects a value as low as that.

Chat with your doc but don't sweat this result.

EdinBaltimore

[stangoldberg]

I think too many guys are fixated on a specific PSA number. It's more important to look at trends over time and if your PSA is correlated with your testosterone number. Since testosterone feeds the cancer, keeping the testosterone low should keep the PSA low. For 27 years my oncologist and I used this principal. My threshold for a hormone injection was a PSA of 3.0. If it crossed the threshold, injections resumed. We have been doing this for 27 years and only once did the PSA rise when the testostorne went down. I opted for an injection and 3 months later everything was again correlated. You might want to discuss this statistical approach with your oncologist. My last PSA was 0.6. My goal is not to get rid of the cancer, but rather to keep it low enough that bone tumors don't form. So far, so good.

[TCMG in reply to stangoldberg]

Curiously do you also do PSMA scan if your PSA reaches 3.0?

[stangoldberg in reply to TCMG]

No we didn't. Although it may have been useful, we relied on statistics. The continual presence of the corrrelation indicated that the cancer cells were still reliant on the testosterone for growth. If there were two consecutive tests where the correlation was not present or was lessening, it would have been time to do other tests. Fortunately, for 27 years that hasn't happened.

[Mascouche]

For people who had surgery, the talk of recurrence begins when the PSA reaches 0.2. For those like me with no surgery but radiation instead, it is when the PSA reaches 2.0 though there is a case to start looking for mets with a PSMA-PET scan once you reach a PSA 1 or 1.5 in order to see if there is a concentration of those cells outside of the pelvic area. If there are those can possibly be radiated and then the song and dance of waiting starts once more.

[j-o-h-n]

Psa is back, Back? it doesn't care how down under you're under........it never goes away...

Good Luck, Good Health and Good Humor.

j-o-h-n

[NanoMRI]

I made it 24 months at <0.010, no ADT, before < dropped. That was four years ago. Not wanting to give this beast time and obscurity, monthly testing tracked next two years rise through 0.01X range into 0.02X range. At fourth year, rose into and been holding very low stable 0.03X range since-(past two years). My focus and strategies are not based on population based guidelines, stats and studies, but rather, salvage extended pelvic lymph node dissection (that was preceded by RP and salvage RT), done at 0.11, confirmed five cancerous nodes, including common illiac and paraaortic. At least for me, the guidelines of 0.2/0.1 for recurrence are wrong and give this beast time, and the use of 'undetectable' results in obscurity. Hope this helps. All the best!

[Blackholes in reply to NanoMRI]

Thanks for that very informative response.

My first upsa after prostatectomy at 6 weeks was <0.01 and remained that way for 27 months. No SRT or ADT.

Because my disease is high risk and after months of researching I came to the conclusion that I would use an upsa reading of either 3 consecutive rises or any reading of 0.03 and rising as my definition of BCR.

A result of 0.05 has a positive predictive value of 92% for conventional BCR (0.2).

So this will be my trigger level for any salvage treatment.

So one upsa result of 0.01 is not enough to indicate a recurrence.

Will know more after the next readings.

[NanoMRI in reply to Blackholes]

My RP nadir was 0,05; now also my actionable number after my unsuccessful salvage RT done at 0.10 and subsequent successful ePLND. At 0.03 I now begin imaging-I learned six years ago in UK they image as soon as 0.03; yes ahead of US guidelines and I am familiar with the 'success rate data' thrown at us. If I cannot achieve the elusive cure, my focus is to defer/delay ADT and subsequent castration resistance as long as possible. Why I did imaging and blood biopsy testing when my PSA began holding at 0.03X.

[NecessarilySo]

I have long thought <0.1 was "undetectable". Mine rose to 4, after 3+ years after RT, when I was diagnosed with aPC, (12 years ago). Lately, past 3+ years, it has been <0.1. Latest test was <0.06.

However:

"According to the American Urological Association, serum PSA should decrease and remain at undetectable levels after radical prostatectomy. The AUA defines biochemical recurrence as an initial PSA value ≥0.2 ng/mL followed by a subsequent confirmatory PSA value ≥0.2 ng/mL."

labcorp.com/tests/010322/pr....

[NanoMRI in reply to NecessarilySo]

yes, that is an established guideline, however it is just a guideline, and cancer can indeed be present and growing well below 0.2. Was for me at 0.1. The guideline needs changing, lowering, but this still seems a long way off.

[NecessarilySo in reply to NanoMRI]

Of course, "undetectable" is a misnomer. Anything detectable is by definition not undetectable. I think our ability to detect has improved over time. Need a better word.

[NanoMRI in reply to NecessarilySo]

I have not found that better word so I decided to use specific PSA values below common guidelines. Based on my readings prior to my RP I chose to rely on <0.010 as a best indicator. My RP nadir was 0.05 - I chose to try salvage RT at 0.11, no ADT. That resulted in a nadir 0.075. As I share when I was back up to 0.1 I tired salvage ePLND after imaging identified five suspicious mets; nadir <0.01. With cancer confirmed at paraaoritcs I now think imaging at 0.03 and further actions by 0.050. I am holding in 0.03X range for past two years, and have began imaging; so far clear as expected.

[NecessarilySo in reply to NanoMRI]

That's incredible. Good job.