After surgery PSA should be undetectable. What does it mean. Once the lab give 0.03, once 0.04. I guess it s the lab (standard error of the machine), but what is the limit of the lab and when should i consider that THERE IS a PSA. Why is PSA still detectable after surgery should nt it be 0.00 ?
PSA undetectable: After surgery PSA... - Advanced Prostate...
PSA undetectable
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cpl901
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depends on the accuracy of the test some are 0.01 some are <0.03 some (more expensive) are ~0.001 and yes the ideal is not detected on any test however many post rp results bounce along at 0.01 to 0.04 the more critical thing is whether there is a change to a trend of sequential rises, and acting on it.
Most modern analyzers, reporting to two decimal places, have an accuracy well bellow 0.01 which serves as their reporting lower limit.
3 clinical trials have now proved that, for most men, waiting for SRT until PSA reaches 0.1 or 0.2 has the same outcome compared to immediate treatment. There are exceptions for very high risk and very low risk individuals. uPSA is a relic of the past -- I wish they would stop doing it.
TA
I hate to criticize you on anything related to prostate cancer info as you are a great resource to our prostate cancer community. However, I wish you would accept uPSA can be useful tool in our tool box to fight this dreadful disease. I know you have all your studies but all I have is me. I had my rp about four years ago with 1 in 10 lymph nodes with cancer & seminal vascular involvement. So cancer had escaped the capsule. After healing up from surgery, I had 2 std PSA’s. Both were <0.1 or undetectable. The fact cancer had escaped the prostate meant further treatment was required. However my std PSA was <0.1 raising the question of waiting for further development. I wanted more info so I switched to uPSA & had 2 readings of 0.028 & 0.026. At that point about a year after my surgery, I had a decision to make. The tests could be wrong but I used the same labs for all testing ( a requirement for using uPSA testing), the surgeon could have left some benign prostate tissue behind ( he had done more than 10,000 rp), some glands like salvia glands can produce minuscule amounts of PSA or I still had some prostate cancer cells floating around in me( most likely the case). Not wanting to play Russian roulette with cancer, I choose 40 round of whole pelvic radiation followed with 2 years of Abiraterone/Prednisone with Lupron/eligard the whole time. Since radiation, I have had 14 uPSA test. One in the middle was 0.006, all the rest were 0.014 done by the same lab or about 1/2 my pre radiation testing. Did I still have prostate cancer after my rp? Probably, but the uPSA testing helped my decision making to be aggressive with my treatment . I do share your concern with a bouncing around uPSA results. My requirement is to use the same lab & the 1st question to be asked with changing results is a change in testing methods
Thanks for thinking about the possible benefit of uPSA
Hopeless case, yet, enjoying an amazing recognition by people intimidated by fractional numbers going deeper than tenths.
I’m glad you wrote this response to TA. What you say is important and needs to be heard. Let me add to your comments but about a different set of patients.
While uPSA can certainly move around very low levels and result in anxiety, it is a valuable tool in helping guide treatment decisions, or, at a minimum, increased vigilance, especially post-prostatectomy. The studies on the high probability that if you reach >=0.03 shortly after surgery, then you are likely to eventually go on to full BCR (>=0.2) are very clear. There is value in that, although it comes with a cost of loss of peace of mind for some
More importantly, I think, in contrast to the widely held belief by that using uPSA always increases anxiety, there is a VERY large majority of patients where it should reduce anxiety…those who have taken one or two post-surgery uPSA tests with very low thresholds (sub 0.01) and come back undetectable on those assays. If you are taking a 0.1 threshold test, and it comes back undetectable, I would not be resting easy, as there is plenty of opportunity for significant cancer to be lurking.
But what about studies that show how much the distribution is skewed toward non-recurrence, especially over the first three years post-surgery, for those with <0.01 uPSa readings AND localized prostate cancer? Fortunately, a recently published paper looked at a few dozen of these uPSA studies over a 20 year period for patients with <0.01 uPSA test results shortly after surgery. As everyone can see in the results at the link below, these studies show an extremely high likelihood of no three year recurrence (around 96%) based on the studies used. That is a strong signal in my book!
On the flip side, if you do have detectable uPSA >=0.01 early post-surgery, it is not at all a guarantee you are going to recur within three years, as the positive predictive rates of recurrence are not that high, which is also shown in the paper below. (Again, for those with localized disease). From Tall Allen’s comments, I believe this positive predictive graph is likely more important to him and supportive of his approach.
The bottom line to me is this: If you are <0.01 uPSA in the first six months post-surgery and had organ-confined disease, the odds are massively, and I mean MASSIVELY, against BCR in the next three years.
Manute
That's what TA said, high/low risk. There is a place for it.
Not exactly what he said. He said very high risk and very low risk. Organ confined disease, in and of itself, is not always low risk (and certainly not always VERY low risk). There are plenty of Gleason 7s that are organ confined but not “very low risk” regardless of margins, due to a myriad of things like high pre-op PSA or large tumor size etc etc. , where knowing after surgery that you are <0.01 is very valuable to one’s frame of mind.
I think your salvage radiation was unnecessary, at least at the time you had it. uPSA gave you a great deal of anxiety, that drove you to take unnecessary action. The unnecessary SRT obviously made you feel better, relieving your anxiety. You provide a good case study of why the uPSA has outlived its usefulness and should no longer be offered.
Maybe uPSA push to fight against a biological number instead of fighting a cancer. That s the bighest problem with PC. But why a biological test still detects PSA (in that case) after surgery done well, negative margines etccc…and how long in the rest of life does it stay 0.0 something and is there a time when one gets cured ? Is there something else to do after surgery to make the PSA dispear, something else than SRT or ADT ?
TA
Again I respect your extensive knowledge which has helped hundreds of our community members deal with the scary prospect of having prostate cancer. However you do know me & you do not know what gives me anxiety. What gives me anxiety is the fact that my cancer escaped the capsule. Did my surgeon get out all my cancer? Odds are great that he did not. How much was left? Not enough to register my std PSA above 0.1. So a std PSA <0.1 or undetectable gives me anxiety. How much cancer was left? Maybe none or maybe he missed one lymph node or two. I don’t understand why a prostate cancer patient would wait for the cancer to grow so that it registers a std PSA at 0.1 or above before taking treatment. The use of uPSA removed my anxiety & gave me the confidence to take an aggressive treatment approach. Maybe I made the wrong decision but it was my decision so please respect that I and my medical team are confident with my aggressive treatment approach. Thanks for listening
It is not important that I agree with you. You have to be the one to be happy with your decision. You can't convince me it was objectively a good decision, but as long as you are happy with it, what is the difference if I agree?
There are some cases where the cancer is still high risk even after surgery. In such cases, adjuvant (immediate) radiation is called for - uPSA is unnecessary and even creates an unnecessary delay in such cases. See this link:
prostatecancer.news/2021/10...
Otherwise, there is no difference in outcomes from waiting, in spite of your strongly held yet beliefs. Decisions should be based on our best medical science, not anxiety.
I agree our decisions should be based on our best medical science but as one of your articles you reference says “ but none of what we learned gives us hard and fast guidelines”. Even the best medical science still contains uncertainty. Each of our individual situations contains uncertainty. For me, the fact that “my cancer escaped the capsule” and “my std PSA was <0.1 or undetectable” created a conflicting message. I found using uPSA addressed that conflict. As a naive prostate cancer patient, I look for clarity to help with my decision making & found value using the uPSA
Until recently there was a guideline to speak from own experiences. When I asked about you overstepping your experiences the guideline was changed. Humm!
Allen, you are wrong regarding usPSA, but then, you have no personal experiences.
I wish you would stop expressing a presumed expertise with no personal experiences.
In fact, I received uPSA every time since being treated. I wish you would stop presuming things you know nothing about. I'm just reporting the science. If you want to state your ignorant opinions, that's up to you.
I apologize and will stand corrected for presuming you do not use usPSA testing because you harshly criticize its value and you are cured - which I think is most awesome and I so would like to be able to say the same.
I am curious - based on your strong opinion why are you doing usPSA testing? Why?
Science changes, can be wrong, is easily biased, and what you cite is deadly wrong on this topic.
Isn't there a guideline about insults? Or a you exempt?
If you look at what I actually wrote,"3 clinical trials have now proved that, for most men, waiting for SRT until PSA reaches 0.1 or 0.2 has the same outcome compared to immediate treatment. There are exceptions for very high risk and very low risk individuals. uPSA is a relic of the past -- I wish they would stop doing it."
As for your ignorance of the science - that is not an insult -- just a fact. Perhaps you might relieve yourself of your ignorance if you look at the science. Here -- I'll make it easy for you:
prostatecancer.news/2019/09...
wow!!!
I am not sure if you two have realized it but you are arguing over different things as Tall Allen keeps referring to uPSA (Ultrasensitive PSA that goes to <0.01) and NanoMRI keeps referring to usPSA (which I believe is the old PSA test that does not go further than < 0.10.
The tests I have relied on for past eight plus years, since my RP, do indeed report to <0.010; confirming <0.010. As I share and note in my bio, for the past three years my PSA has held very low stable 0.03X. My salvage extended pelvic lymph node dissection surgery, done over six years ago, yielded a PSA nadir of <0.010, which held for two years. I find testing to <0.010 very reliable, including testing in many different labs, and very useful, critical in my decision making process.
Ok then I think that means the test you are using is the uPSA and not the older usPSA
Though I could be wrong. Here is what the AI says
What is the difference between uPSA, usPSA and just PSA ?
Copilot
Certainly! Let’s break down the differences between uPSA, usPSA, and PSA:
PSA (Prostate-Specific Antigen):
PSA is a protein produced by the prostate gland. It is commonly used as a biomarker for prostate health.
Elevated PSA levels can indicate various conditions, including prostate cancer, prostatitis (inflammation of the prostate), and benign prostatic hyperplasia (BPH).
The standard PSA test measures the total PSA level in the blood.
uPSA (Ultrasensitive PSA):
uPSA is a more sensitive version of the PSA test.
It can detect lower levels of PSA, which may be helpful for early detection of prostate cancer.
uPSA is often used after prostate cancer treatment (such as surgery or radiation) to monitor for recurrence. A rising uPSA level may indicate disease progression.
usPSA (Free PSA or Percent Free PSA):
usPSA measures the proportion of free (unbound) PSA to total PSA.
Total PSA includes both free PSA and PSA bound to other proteins.
The percentage of free PSA can help differentiate between benign conditions (like BPH) and prostate cancer.
A higher percentage of free PSA is generally associated with a lower risk of cancer.
Not sure this u or us distinction is well understood nor settled.
Not to start additional disagreements, consider this statement on my LabCorp 3rd generation ultrasensitive PSA result report - "The AUA defines biochemical recurrence as an initial PSA value 0.200 ng/mL or greater followed by a subsequent confirmatory PSA value 0.200 ng/mL or greater".
Post RP I consider values above 0.010 concerning, learned to take further investigative actions such as imaging and blood biopsy testing by 0.03X, and will now act with treatment no later than 0.050; my RP nadir eight plus years ago.
T
Swap the names and you got it right.
Yep 
What is the difference between uPSA, usPSA and just PSA ?
Copilot
Certainly! Let’s break down the differences between uPSA, usPSA, and PSA:
PSA (Prostate-Specific Antigen):
PSA is a protein produced by the prostate gland. It is commonly used as a biomarker for prostate health.
Elevated PSA levels can indicate various conditions, including prostate cancer, prostatitis (inflammation of the prostate), and benign prostatic hyperplasia (BPH).
The standard PSA test measures the total PSA level in the blood.
uPSA (Ultrasensitive PSA):
uPSA is a more sensitive version of the PSA test.
It can detect lower levels of PSA, which may be helpful for early detection of prostate cancer.
uPSA is often used after prostate cancer treatment (such as surgery or radiation) to monitor for recurrence. A rising uPSA level may indicate disease progression.
usPSA (Free PSA or Percent Free PSA):
usPSA measures the proportion of free (unbound) PSA to total PSA.
Total PSA includes both free PSA and PSA bound to other proteins.
The percentage of free PSA can help differentiate between benign conditions (like BPH) and prostate cancer.
A higher percentage of free PSA is generally associated with a lower risk of cancer.
Ok thank you Allen. You have a lot of interresting information here for all. But we are not all just trials and statistics. We are here for sharing our experiences. Your advice after my diagnosis dicember 2022 was not to do surgery because of the side effects, and the sexual life of gay and bi mens. ok. I understood but it just delayed (time to informe myself etccc) my decision to do surgery and at the moment i dont regret it at all. (better urinating, non toxic treatment, new sexual life ok but still manageable). Now the follow up is PSA testing and that was the reason from my post that made this discussion start. Apologise.
Now my next question is : i did this PSA test 0.04 together with a Testosteron test to see if my testosteron level would have changed before and after prostatectomy. Before it was 27 nmol/ml done in the morning before 9 now it is 36 (too high for my age 58) also done before 9. And i didnt do anything for it even less sport that before surgery.
As these cancer cells are feeding with testosteron, do i have a chance without ADT to have my PSA staying "undetectable" at 0.04 for instance or should i expect it to rise sooner or later. If this "undetectable" is just the lab-machine that gives a number what is "undetectable" because the machine is trying to detect something.
Is this remaining PSA just due to some prostate cells anywhere in the body (maybe not cancer).
I will talk to the urologist, but as everyone knows here too. His job was to get out the prostate and the cancer cells. He did well : negative margine (path report T2N0M0), Gleason downgraded 3+4 but in different part of the gland.
For my urologist the answer will be : Sir your ok.
But what after ? Am i cured ?
I m not anxious , i just want to be prepared. How i will react if the answer is : Sir your not ok. I m not the guy to run in a therapy (rather the oposite because i dont trust easily)
What i would do : anything to maintain a QoL, and of course stay healthy until the end.
I wish all the best to all the guy s here. And i thank them all for the help.
I have learned and am still learning (by practicing mindfulness) to be with things as they are and to not let my mind race ahead to imagined fictional futures. Your imagined dialog with your urologist is an example. You are just fine for now.
My Doctor from Johns Hopkins said to use the uPSA test and if it ever became detectable (lose the “<“) then I would need to start early salvage radiation because I am high risk. I heard the same thing from Daniel Spratt after consulting with him. I am a firm believer in its value for high risk individuals.
this is also what mine said, though at a slightly higher level. mine was 0.01, <0.01, 0.01 and 0.01 .. he said well over coming year if it goes to 0.03 then action. If I was using 0.1 testing, action would come late. If I am gonna have bcr I instinctively want it when volume of cancer cells are lowest.
My question to the group is:
If something is considered undetectable how can you call it undetectable if you can't detect that it's undetectable?
Good Luck, Good Health and Good Humor.
j-o-h-n
I have nearly 100 PSA tests over many years, which began prior to my diagnosis, done in different labs across the US and in other countries. Always consistent, always reliable. Based on my experiences and extensive research I do know this subject very well.
"Undetectable" is a dangerously misleading, variable meaning term. The < does not mean undetectable, as if 'none'. It simply means the lab is not reporting below the selected value.
Post RP I rely on <0.010 as best indicator. My post RP nadir was 0.05 - we accepted cancer remained. Monthly, I tracked my rise to 0.11 and tried salvage RT to bed, no ADT. Nadir 0.075; we missed some.
When my usPSA was back up to 0.11 I traveled to the Netherlands from US for imaging, the Ferrotran nanoparticle MRI trial. Five suspicious pelvic nodes were identified. Salvage extended pelvic lymph node surgery with frozen pathology section method confirmed six cancerous nodes - including the para-aortic.
Imagine if I had waited, listened to others who dispel ultrasensitive testing,
For the past six years plus since my salvage ePLND I have been testing monthly with ultrasensitive testing. Here is a summary of the results.
23 months at <0.010; for first 12 months I took bicalutamide for added insurance.
8 months in 0.01X range (I test to thousands, which does vary a bit in thousands - good reasons for this).
7 months in 0.07X range
36 months in 0.03X range.
Annually I do comparative imaging and blood biopsy testing. My intent is to not give this beast time and obscurity and if it comes to it, to defer ADT/chemo and thereby CR for as long as possbile.
I welcome discussions and challenges on this topic, but if you have no personal experience, please keep this in mind; telling men to wait until a higher PSA value buys docs time, saves monies, and sets men up to have no choice but ADT; a easily delivered highly profitable treatment.
Thanks for sharing your experience and your choice. I can imagine this run was also quiet expensive. At least you avoid ADT. Do you know or have heard other methods like diet or else that could help the immune system to "kill" the rest of the cancer cells ?
The costs for combined imaging in Netherlands (nanoMRI, Ga 68 PSM, CT) and salvage extended pelvic lymph node surgery in Belgium were less than a luxury ski holiday in Europe. As much as I love to ski, and especially in Europe, well worth foregoing a trip or two.
Regarding diet, yes after much reading I made the decision to try and help my immune systems go after remaining cancer cells, maybe cancer stem cells ( I concluded, why not try!). As shared in my bio, my unproven efforts include: reduced methionine and choline diet; Phytochemicals targeting cancer stem cells including Curcumin, EGC, Sulforaphane, Resveratrol, Genistein. Additional supplements include Bergamot, Lycopene, Boron, VitD. I also maintain Ferritin <75 ng/mL. (Earlier this year, 2024, I was diagnosed with hemochromatosis - now I have two reasons to maintain a lower Ferritin level.)
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