Difference?

[DianeMax]

My husband has been receiving PSA tests since his prostectomy in March 2023. They have been <0.1. He just had another PSA test, but it was a screening PSA which showed 0.1. Any difference in regular PSA tests and screening PSA tests?

[Justfor_]

Single decimal place PSA tests after prostatectomy are only good to keep the patient distracted and happy. Such "happiness" bears an expiration date.

[Channelhomec in reply to Justfor_]

So very true I wish doctors were more up front they just lead you to believing you are cured or in remission my uroligest strung me along for six years until I hit 0.13 psa >salvage failed 5 years later... should have done something lower psa..

[NanoMRI in reply to Channelhomec]

this is what we are offered in a medical culture that seeks to treat this beast as a chronic illness and not the debilitating deadly disease it is.

[Tall_Allen]

Same lab?

[DianeMax in reply to Tall_Allen]

Yes, same lab. We are a wreck about the increase from <0.1 to 0.1. Trying to see the urologist soon for further steps. I’m assuming radiation would be the next step or would we push for a PET scan?

[Tall_Allen in reply to DianeMax]

No need to react quickly. See if it is sustained next month.

[DianeMax in reply to Tall_Allen]

Thank you! I appreciate you being here for us. It’s difficult to get answers from doctors right away.

[Ilovemyhubby96]

I totally understand the stress and fear. But just take some deep breaths. It sounds like a great test result I would believe you doctor will just redo the test next month . Praying 🙏🏼🙏🏼🌸

[RMontana]

I believe the two results are the same; less than 0.1. Now there is something called a uPSA (ultra low PSA) assay, or test. This test will go down into the 'thousands' of ng/ml. But, you have to decide if you want this level of sensitivity; there are pros and cons. I have written a lot about this. Basically, you can take the standard test and as long as the PSA does not rise to or above 0.1 you are good to go. Or, you can take the uPSA and 'see the train coming on the tracks.' That is basically the difference. uPSA can give you up to a 14 month heads up that you will have BCR (biochemical recurrence). What type of person are you and will this level of sensitivity add to, or detract from your QOL (quality of life)? Asked another way, if you could have 14 months of head up, what would you do with it? Is this warning of any use to you? So, that is my opinion on this...good luck. Here are some links you can read. TNX Rick

healthunlocked.com/active-s...

healthunlocked.com/active-s...

healthunlocked.com/active-s...

PS in the end, once the PSA goes above 0.2, then its PSA doubling time that matters. At uPSA PSADT does not work; its only a heads up...TNX2

healthunlocked.com/active-s...

[NanoMRI in reply to RMontana]

I have never heard nor read of this 'up to 14 month heads up' use of uPSA. And I see no role for doubling time post RP. But then, I have learned to not give this beast time and obscurity.

Twice post my RP 0.11 was my actionable value for treatment. Since my ePLND I reset to 0.050. All the best to all of us fighting this beast.

[Hawk56]

Just my experience...after my surgery, labs were every three months and the results were using the standard PSA test, measured to a single decimal point. For the first 12 months, all were <,1 then at 15 months .2 followed by a subsequent test at 18 months, .3.

Despite a very successful surgery, my GS of 8 - 4+4, gave me a 30% chance of BCR based on MSKCC nomogram. Should I have done adjuvant therapy, well, I still had a 70% chance of no BCR, so,based on the pathology report, we elected not to.

As RMontana has said, an USPSA test could provide early indication of a BCR. Question is, would it change a treatment decision...?

A question to discuss with your medical team may be if the PSA continues to rise, do they foresee imagining, if so, what agent will they use and at what PSA would they image?

My medical team and I have decision criteria about imaging, three or more consecutive increases, PSA between .5-1.0 . That decision criteria is in place for several reasons. We feel it provides a better chance of locating recurrence which is a key piece of the clinical data informing our treatment decision. Granted, you can image at PSA below .5 and there is some probability of locating the recurrence but is drops by roughly half. We also feel it does not entail risk in the PCA getting out of control and thus altering our treatment decision.

While there is some discussion about a cure after surgery when PCa comes back, that is not my case. So, we treat to manage my PCa, aka a chronic disease, when it recurs, hit it early and hard for a defined period, come off treatment based on my response, and actively monitor.

My PCa is high risk, GS 8, GG 4, time to BCR, PSADT and PSAV, so, we actively monitor and treat aggressively.

Perhaps discuss with your medical team what they envision if this is indeed a BCR. Long ago and far away, SRT to the prostate bed was the standard of care and there was discussion about the earlier the better. BCR then was generally defined as two or more PSA results .2 or higher (now with the USPA...), My understanding is that is less so today though not entirely out of the treatment decision making realm. Today my understanding is doublet and triplet therapy is more often mainstream in clinical practice, ADT+ARI, radiation can be used in concert with imaging or just used if no imaging. If the latter, then the discussion turns to not just the prostate bed but to include the PLNs and how high up...

There are other pieces of the clinical data that come into your decision making with your medical team based on the pathology report - Gleason Score, Grade Group, time to BCR, PSA doubling and velocity times...

So, perhaps take some time to read and understand the NCCN guidelines to guide your discussions with your medical team, don't hit the panic button, if and when the clinical data is there, there may be choices to either go for the cure or manage his PCa, depending on the clinical data.

In the meantime, just live.

Kevin

Clinical History

[RazorSaw in reply to Hawk56]

Wow Kevin, I am so impressed. This is one of the reasons why I joined this forum. People like you admirably turn a long clinical history into a readable narrative that can benefit the rest of us. I hope one day that I can emulate your example here. Kudos!

[DianeMax in reply to Hawk56]

Thank you so much for the response. I certainly appreciate it!

[DianeMax in reply to Hawk56]

Thank you so much! I appreciate the response.

[treedown]

Just a side note about addressing recurrence at a PSA of .5. Your insurance company may say not until 2. That was my case with Kaiser despite my MO saying .5. I had to have a CT and bone scan before they approved a PSMA Pet scan on my recurrence. By the time a decision was made on how to proceed my PSA was over 3. Better insurance or Medicare will allow it earlier. Mine is the top tier on the insurance that is available to me in my state. A few more years and I'll be on Medicare.

[Union98]

Husband's oncologist office enters the PSA reading in the portal without the less than sign. This has been going on for years. It's a possibility that the software won't allow the character but we don't know that for a fact. He has his blood drawn a week before his appointment (the office thinks he eccentric because he wants the doctor to have his test results when they actually meet-seems like common sense to me lol ) so he is able to confirm at his appointment that his PSA is still less than. They have no idea the stress they cause by not addressing this but he likes his doctor so he puts up with it.

[Jpburns in reply to Union98]

My oncologist listed my last 2 PSA tests as “no data,” which wasn’t reassuring. I called to check. That apparently means undetectable. Whew!

[j-o-h-n]

And your dear husband's age is ??

Good Luck, Good Health and Good Humor.

j-o-h-n

[DianeMax]

He’s 59.

[JobViktor]

PSA level after Prostatectomy should be zero, But dont worry man normally has still PSA as long as it's normal prostate not in contrary (the tumor marker). In man there are normal n abnormal PSA so as to make sure just keep testing PSA periodically every 3months minimum. If it raise significantly..let say : 2 it could means a relapes. Talk to your MO to find the best cure. There are many choices you can choose. My prayer for your hubby recovery. Regards from Indoneisa PCa survivor

[NanoMRI]

'Regular' and 'Screening' are pretty nebulous terms as is much of the information and disparities surrounding this disease. One of the first big disparities to address is what value to rely on post RP as best indicator. This relates to RMontana's good metaphor - do you want to see the train coming down the track? As I want to see and hear the train as soon as possible I rely on <0.010 as best indicator.

One stand alone test is not a trend but because of your bio notation of positive margins I would be taking actions. First would be two more tests. IMO tests that report to hundredths - even better is to thousandths. I would have the first of these straight away and the second no later than another 30 days. If your doc will not agree, depending on where you reside, you can self advocate and get them on your own; Walk In Labs and RequestATest are two available testing services. (Note, I have done a lot of testing over the past nine years since my RP, (I was 58, G 4+3), in different labs across different states and other countries - all consistent, all reliable).

As for other next steps again we face disparities. With the positive margins I would be seeking several types of imaging and liquid blood biopsy testing no later than 0.050.

FYI, my views are based on my experiences and my intent since my Dx, that if it comes to it, to defer ADT/CR as long as possible. I have and will continue to do all I can to not treat this disease as a chronic illness.

Hope this helps. All the best!