I’m 9 years post RP
3+4 for 7
Good patho post RP
My psa since has been
Always undetectable
<.1
.02
<.1
<.02
About 3 months ago it was .05
And after a retest it was <.06
My uro says I am undetectable
And he will see me in a year
Does this seem right?
Question about my annual post RP psa ... - Prostate Cancer N...
Question about my annual post RP psa reading???
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Tommy459
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•
<0.06 is undetectable, but 0.05 is not. The less than sign ("<") means that the actual PSA was below that lab's ability to detect it. Different labs have different lower limits. You should always get tested at the same lab. If they were from the same lab, you can ask if they changed their test kit.
Good point. Just had a PSA this week, was <.05 ng/ml. and had some questions for my surgeon--one of which was (since going to MSK kills a half day for me) if I could follow up locally--and he said fine. So if my next reading is not undectectable I have to get info on the labs.
So since my last test is <.06 does it make sense that I’m ok for another year as he says ?
My .05 was first
Same lab
Retest same lab 2 months later
Result
<.06
Does this make sense Allen ?
I would call the lab and ask why the lowest reported value suddenly became 0.06 ng/ml. It may be that they changed the test kit they use for the assay.
But your PSA is barely moving, if at all. since your post-prostatectomy pathology was good, it makes sense to wait a while.
Also Allen
i think the doc ordered the Upsa test when I got the <.06 result
Oh - so the "<0.06" might have been on a different (less sensitive) test. That makes sense.
Well
I thought upsa was the ultra sensitive test?
Yes, it is. Didn't you just say that he ordered the uPSA when you got the <0.06 result? So the <0.06 was not on a uPSA test?
No
I thought he ordered a uPSA
And <.06 is the result
OIC
I hope that makes sense. My Dr. seemed pretty confident that I was undetectable and then I shouldn’t worry but of course like a lot of us I do. Thank you for your thoughts and input— means a lot
"<0.06 is undetectable, but 0.05 is not." Last time I looked, 0.05 < 0.06. ??
<0.06 means undetectable by that lab
0.05 means detectable by the other lab
Detectable/undetectable means if the specific lab could measure/not measure PSA. There could be PSA in the patients even if the lab can't measure it.
It's the "<" symbol that means the PSA is undetectable.
Thank u!!!
Your PSA is still low. Look for long term trends. There are other reasons for an increase in PSA.
Thanks Magnus
What other reasons are there other than prostate cells (normal or cancerous) creating the antigen?
Inflammation of the prostate, infections, irritation of pelvic floor from riding a bicycle, etc.
Does that even apply post prostatectomy?
Exactly why I asked, LOL. All good reasons if you still have a prostate!
From what reading I’ve done there are potentially still some tissues that can produce small psa quantities even after RP
Someone will correct me if that’s wrong !!
Even without a prostate there remains the possibility of irritation and infection.
RALP Aug 2018 with following PSA values, all at same LabCorp facility
0.021 Oct 2018
0.018 Jan 2019
0.022 Apr 2019
0.028 Jun 2019
0.035 Oct 2019
My medical oncologist says that tread shows the certain need to begin early SRT. The radiation oncologist is not so sure that I need to start SRT now. MO is willing to let me get another µPSA in January 2020 and April 2020 before we make a decision. But, MO is 100% certain I will eventually need SRT. That is due to adverse pathology (SM+ and EPE) but the 2 mm/G6 tissue was co-located and single focal so I am hoping for a radiation free life.
I will receive my Decipher genomics (pathology) results this week so might have better/more complete information soon.
OTH - he also told me that he normally only tests at one significant digit and all of my tests would have been PSA < 0.1 (UNDECTABLE) and I would not have to be making any decisions or even worrying at this point.
My rising µPSA trend is why he does not like µPSA - it forces men to worry and try to make decisions long before they are necessary. My current trend indicates I will have UNDECTABLE (<0.1) PSA for at least another 18-months, which offers a pretty good long term prognosis.
Maybe we have too much information?
My research says wait until 0.1 ... I've been hovering <0.03 to 0.05 for a couple of years ... Research says go at 0.1 as high chance of getting to 0.2 if I get to 0.1.
Agree
And your PSA may hover in that area for the rest of your life—decades...at least that’s what my research shows and I think my urologist agrees. My urologist says test at the .1 threshold and don’t worry until it gets above .1 then will watch it closer.It May Never get to that level.
I suppose that also depends on what our post RP pathology is.
I agree, too much information.
Anything UNDER 0.1 ng/ml is clinically undetectable. I wouldn't worry about measurements in the hundredths. I don't believe any lab can measure that closely within acceptable margins of error. My lab just records it as less than 0.10. As Tall_Allen says, always use the same lab.
One thing bothers me about using regular PSA instead of ultra sensitive PSA after RP. With regular PSA, upward trend possible values are:
<0.1, 0.1, 0.2, etc.
These numbers have only one place after the decimal point. Since 0.2 is when biochemical recurrence starts, there is little warning before it occurs.
Compare this with using ultra sensitive PSA. Then, upward trend possible values are:
0.01, 0.02, 0.03, ..., 0.09, 0.10, 0.11, 0.12, etc.
Now we have 2 decimal places and we can see a trend when PSA is detectable, but still not up to biochemical recurrence. Thus, further treatment could start earlier then at 0.2 which might improve chances for a cure.
This is why I disagree with my surgeon who only does regular PSA.
I'm currently in that position, with a PSA that was undetectable for several years, but is now floating around between 0.07 and 0.13. I'm tempted to start salvage treatment before I get up to 0.20.
(I am using the same lab for consistency.)
Any thoughts?
Is 0.2 where treatment starts for biochemical recurrance? Based on? I don't know and am curious - and I'd assume that's for people who've had surgery?
You also said "I'm currently in that position, with a PSA that was undetectable for several years, but is now floating around between 0.07 and 0.13. I'm tempted to start salvage treatment before I get up to 0.20."
The phrase "now floating around" to me - implies ups and downs. Is it a steady trend up, or has it been up and down? That would make a difference in how seriously I'd take the 0.13 reading.
Sorry I didn't mention that I had a prostatectomy, so PSA should be zero afterward. In that case, it seems to be standard to define biochemical recurrence as a PSA of 0.2 or greater.
By floating around, it was increasing for several years 0.05 up to 0.11, and then it decreased for a year back to 0.07. In the last year it has increased from 0.07 up each time until it reached 0.13.
The purpose of my previous post is that I think there is value in using the ultrasensitive PSA in situations like mine because it gives more warning of an upcoming recurrence than regular PSA. Regular PSA only gives 3 values before it is time to treat the recurrence: <0.1, 0.1, and 0.2 (only one decimal place). That makes it harder to consider treating BEFORE the PSA reaches 0.2. Do you treat with it at 0.1? Probably too soon. Oops! It is now 0.2. Gee, I wish I had treated it sooner to get a better chance at a cure. Many doctors don't believe in ultrasensitive PSA, but it does give the patient a heads up earlier.
Hmmm
Well for whatever reason my uro says he wouldn’t treat anything under 0.2 in my case
I have Always felt that if I got above .1 then I would start getting the ultra sensitive test to see yet edge up to .2.
I don’t know
I was told that the probability of a cure is greater with lower PSA values, and one radiation oncologist wanted to do salvage radiation when my PSA was less than 0.10. If it weren't for the side effects (especially for the ADT!!) I might have let him do it.
PSA test is nothing but a measurement.
As such, it has an inherent sensitivity, min measurable value, linearity, dynamic range, etc.
All these are defined by the equipment and assay manufacturers at the approval stage.
When it comes to everyday-use at a lab, it is allowable that the above are relaxed by 20% (they have funny-pompous names to distinguish the two). This is understandable as the human factor enters the equation (they advise for the same lab, BUT NOT for the same lab person, which is unrealistic for big lab firms), calibration frequency, etc. To cut short my "lecture" on measurements' variability, repeatability and accuracy I would consider this (officially acknowledged) 20% as noise.
What I would do in your case:
a) Take all past measurements prior to the late rise and calculate their mean value. This will be your baseline. The term "late rise" is ambiguous, so you have to statistically test a couple of time samples before and after this (estimated) point to see where they belong. I acknowledge this is an advanced level chore but I had to mention it for completeness.
b) Take your, as in a), derived baseline and all subsequent time samples and do a data linear (see bellow) regression in an Excel sheet. I would say that if you get a fit of 0.75 or higher you have very high confidence of BCR being brewing.
Advanced level hint:
If an exponential fit will come out better than the linear one, then this should be understood as a reinforcement to a BCR detection.
c) Calculate PSA Doubling Time from the time samples as of b).
Disclaimer: I am an engineer by profession
GranPaSmurf• in reply to
SPOT ON! Even though it's been decades ago, I did this kind of data analysis as Chief Medical Technologist. We established confidence ranges for every analyte measured.
No lab result is exact. In modern laboratories the confidence range is so infinitesimal it is insignificant for most common tests.
Variables, besides within the lab, can stretch back to the expertise of the phlebotomist, the time until analyzed, temp while transportation, etc.
Most common analytes (blood chemistries) are accurate enough for the result to be used for diagnosis and treatment.
However, a test like an ultra-sensitive PSA will have a wider confidence range.
As for me and my body, I would never allow a diagnosis or treatment decision to be made from a change of 0.01.
• in reply toGranPaSmurf
Thanks GranPaSmurf. I am in agreement with you 100%, σ=1e-14 (smiling face here)
Ditto (from an ex research scientist).
There are no confidence numbers or margin of error numbers like 0.01 +/- 0.01 (which would mean that reading is basically meaningless. It could be 0.00, or 0.01 or 0.02..) Repeatability in any test when you start heading for really ultra-sensitive readings should have a margin of error readout.
The ultra-sensitive numbers might have some significance if they were going from > 0.01 (meaning they can't measure it at the most sensitive setting) to 0.09 - that's enough change to be able to say "something" is happening. Otherwise - they're just noise.
I often take my BP after I exercise at the gym. I'll do 3 readings. One may be 140/70, another 130/65 and the last one 120/60. Which one is believeable? Can't really say. All that can be said is the BP is 140/70 OR lower. If my upper limit for BP is that number - then I'm OK.
It would be interesting to have 3 reads of a PSA blood sample done at something like 1 hour intervals. Bet'cha the differences for the same sample are more than guys are worrying about here.
Oh - one other thing. Different treatments bring different expected results. Cutting it out brings the expectation that it will be somewhere > 0.1. Zapping it with radiation means it can be between >0.1 up to 2.0 (or even more) since there is remaining prostate tissue in the body. Different treatments - different results.
Jack71• in reply to
I am also an engineer, or I was one before I retired. I have been recalculating the PSA doubling time each time I get a new reading, using an exponential fit. Most of the time, the doubling time has been many years. With the new 0.13 reading, the doubling time has shortened to 6.5 years, which is still pretty good. That is why I'm not jumping into radiation/ADT yet.
• in reply toJack71
I wouldn't use all the past readings to compute the doubling time. The idea is that PCa has been dormant for years and at a certain point in time it woke up. I would try to spot this time by using groups of samples both from the start as well as from the end of this time series. In math terms think of it as the succession of the exponential curve to a preceeding flat line, all with added noise. It is the "discontinuity" between the two that best signals the PCa wake up scenario.
Difficult to spot, I know, especially with a limited number of readings, but using them all indiscriminately definitely leads to a skewed PSADT value.
For this reason two, out of MANY, proposed ways for calculating PSADT dictate:
1) Discard all readings prior to a dropping one.
2) Take into account only the last 3 readings if and only if they form a rising sequence.
Jack71• in reply to
justfor:
Using either of your 2 options leads to essentially the same PSAdt = 15.6 months.
(This ignores the previous 15 PSA readings.)
Not quite so optimistic but still long enough that I want to wait to see the next result before taking any treatment action.
• in reply toJack71
I agree. Based on this DT I would tested its validity by having the next PSA test when this calculation predicted an advance by 0.02 units.
PSA = permanent state of anxiety for all of us
youtube.com/watch?v=SlIR3Uj...
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 10/31/2019 7:57 PM DST
Be happy with your results they are good
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