RP 4yrs ago, PSA just went to. 2...concerning? Thoughts, please?

[KCCnola]

Had RP 12/19. PSA was "undetectable" until 10/23 when it went to .2, then 12/23 was at .1, then 2/24 was .2 again...PET scan in 1/24 did not show anything...57yo male here. Thoughts? Concerning?

[GP24]

At 0.2 ng/ml a PSMA PET/CT will often not detect anything. You should get salvage radiation now as this study recommends: pubmed.ncbi.nlm.nih.gov/287...

[NanoMRI]

I was concerned when my post RP nadir was 0.05; but then I rely on <0.010 as best indicator post RP and feel 'undetectable' can be very misleading. I had five pelvic lymph node mets confirmed by salvage extended lymph node surgery, including one para-aortic node, at 0.13. Various imaging methods indeed miss mets at lower PSA levels - I experienced this first hand. All the best!

[Tall_Allen]

What were your pathology findings?

[KCCnola in reply to Tall_Allen]

transrectal biopsy showed 12 out of 12 samples contained cancer cells....seminal vesicles & pelvic lymph nodes were removed...lymph nodes were free of cancer cells, but apparently there may have been the possibility of some indeterminate issue with the right seminal vesicle (never quite understood what they were saying, but they did emphasize that it was "more than likely nothing")... currently scar tissue around where urethra was connected to bladder. PSA immediately following RP was .03 then dropped to less than .01...was "undetectable" until this .2, .1, .2 deal (all thru labcorp). This what you were asking?

[Tall_Allen in reply to KCCnola]

No. I was asking about your post-RP pathology results specifically. Gleason score? Positive margins? Size of prostate tumors?

[Justfor_]

You are a victim of the quantisation error, also known as the rounding error. Your past "undetectable" was imaginary and your latest PSA counts place you somewhere between 0.1 and 0.2 without knowing exactly where. After RP the PSA should, at least, be reported to the second decimal place, or better to the third, so that PSADT can be derived. With your single decimal tests you are deprived of this valuable piece of information. I am aware that the average silly/lazy doc pushes the sophism that more reported digital places only add to patient anxiety. Time to cut links with any such person.

[Cyclingrealtor in reply to Justfor_]

Good point! I asked my urologist about usPSA of .xx or .xxx and he gave me that excuse - it just causes anxiety.

At 8 months post RP I went from .1 to .4 in 9 weeks. So no clue what my nadir was and I'm quite confident a .xx or .xxx nadir would have caught the recurrence way before the 8 month mark.

With the acceleration a psma detected a deep right iliac obturator lymph node. That was treated with 33 rounds of EBRT and adt.

[maley2711 in reply to Justfor_]

Are there studies showing a much better life expectancy using the ultrasensitive test "

[Justfor_ in reply to maley2711]

Of course not. Results like: "much better life expectancy" are the happy outcomes of right actions. Enhanced information like: "using the ultrasensitive test" does not trigger or sustain any kind of action by default. There is the need for the right "actuator" for the input to produce an output. And all "actuators" are not made the same, else there wouldn't have been this proverbial phrase:

"When the sage points at the moon, the fool looks at the finger"

and gets "anxiety", I would add.

[maley2711 in reply to Justfor_]

whatever.

[SeosamhM in reply to Justfor_]

You had me at “quantisation error”! Brilliant post.

[jfoesq in reply to Justfor_]

FYI MSKCC in NYC, one of the leaders in PCa treatment only measures to the 2nd decimal. I think their belief is that measurements beyond that are of no help in determining extent of illness and/or treatment decisions. And- you measure below .05 they don't indicate what that "below" number is, they merely state "<.05"

[Justfor_ in reply to jfoesq]

For two decimals resolution the 0.05 is the value where the purported PSA max measurement error (20%) is on par with the rounding error. For any inferior value, the latter supersedes the former. Hence, their ban on any lower figure is a direct consequence of their reporting precision preference. It is an honest attitude of not reporting ambiguous figures. For the exact same reasons single decimal reporting should be low bounded to <0.5. But, such "fine print" is too heavy to digest for the average medical practitioner that only wants to know some relevent "magic" number.

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

Quantization error, is what turned my ex-wife into an over ate/over weight rounding error.

Good Luck, Good Health and Good Humor.

j-o-h-n

[allie2020]

Well shoot. I think you should go with the ultrasensitive PSA tests from now on. I had my RP in 2018 and after my first two standard PSA tests I told my Uro I wanted only ultrasensitive tests. He was fine with it. I think you should answer TA's question regarding your post-surgery pathology. If my PSA gets close to 0.1, I will start looking seriously into treatment, probably salvage radiation.

[Don_1213 in reply to allie2020]

You said: "I think you should answer TA's question regarding your post-surgery pathology." - exactly what I was thinking when I read his bio. Surely they did pathology on the removed prostate... what were the numbers then?

[London441]

You had a PSA of 62 and a Gleason 6? Other than being .03 after the surgery, what else was found? 6 does not sound right for a PSA of that number.

[j-o-h-n in reply to London441]

Wait a minute.......... you forgot the part about exercise and lifting weights...Too much creatine in the afternoon tea Eh?

Good Luck, Good Health and Good Humor.

j-o-h-n

[London441 in reply to j-o-h-n]

Easy big fella. You know I don't push lifting in all my replies you know that. Only 95% of them.

[KCCnola in reply to London441]

I don't know the answer to this, but....transrectal biopsy showed 12 out of 12 samples contained cancer cells....seminal vesicles & pelvic lymph nodes were removed...lymph nodes were free of cancer cells, but apparently there may have been the possibility of some indeterminate issue with the right seminal vesicle (never quite understood what they were saying, but they did emphasize that it was "more than likely nothing")... currently scar tissue around where urethra was connected to bladder. PSA immediately following RP was .03 then dropped to less than .01...was "undetectable" until this .2, .1, .2 deal (all thru labcorp).

[KCCnola in reply to London441]

transrectal biopsy showed 12 out of 12 samples contained cancer cells....seminal vesicles & pelvic lymph nodes were removed...lymph nodes were free of cancer cells, but apparently there may have been the possibility of some indeterminate issue with the right seminal vesicle (never quite understood what they were saying, but they did emphasize that it was "more than likely nothing")... currently scar tissue around where urethra was connected to bladder. PSA immediately following RP was .03 then dropped to less than .01...was "undetectable" until this .2, .1, .2 deal (all thru labcorp).

[London441 in reply to KCCnola]

I would have my slides reread if I had a Gleason 6 and a PSA of 62.

[FlyJ]

I also had a RP in 2019 with at first undetectable psa (<.1) then rising to .1 after 9 mos , staying at .1 for 30 mos and then .21 in12/21 and 2/22. Then dropping to .18 on 3/28/22 and then .15 on 5/18/22. These values all without treatment. (see my profile for details)

Saw RO and decided to "wait". PSA then rose to .17 on 7/22/22 had Gallium 68 PSMA Pet scan- negative. Because of Gleason 9 and Decipher score of .81 decided on Radiation Rx to prostate bed and pelvic nodes. Also short course ADT.