PSA and NLR after RP. What to make of these numbers?

[piousheart]

This group has been incredibly helpful for our entire family. We have a consultation coming up with the Dr. But wanted to tap into the collective expertise of the group as well.

Some background:

Father, age 65 years

Mar 2020: Biopsy indicated Gleason 7 (3+4), G2 grade, 2/12 cores showed adenocarcinoma

Jul 8, 2020: NLR = 2.0

Jul 15, 2020: Had RP. Histopathology report = pT2N0Mx

Aug 20, 2020: NLR = 7.5

Sep 7, 2020: First PSA post-op = 0.017

Oct 1, 2020: Second PSA = 0.028 and NLR = 9

Questions:

1. How should we read these PSA levels post-op? I’ve read mixed opinions about them. Anything below 0.2 is ok vs. 0.03 is ok so not sure which one to reliably consider

2. His NLR is also something that bothers us and it has gone up only after RP, pre-op it was 2 (within the <3.3 acceptable range)

Thanks for your guidance

[Tall_Allen]

Congratulations on the low post-op PSA!

Why do you care about NLR?

[piousheart in reply to Tall_Allen]

Hello! And thanks for your quick and expert guidance, always!

re: low post-op PSA, we were super happy to see the first low number but the tiny rise in the second one made us a little nervous. Does the small increase matter?

re: NLR - I'd read some posts here that high NLR might be early indicator for bCR?

[Tall_Allen in reply to piousheart]

What you are calling a small increase is within the error of the test. Tale the test 10 x and you will get 10 different results within the standard error. Stop the NLR nonsense - what does it give you but anxiety?

[piousheart in reply to Tall_Allen]

Lots of anxiety 😞

[Tall_Allen in reply to piousheart]

Another source of anxiety are the monthly uPSA tests- why would you do that to yourself? Every 3 months is fine.

[CHPA in reply to piousheart]

what does your dad's doctor say? He is the best judge of test results.

[piousheart in reply to CHPA]

We are meeting with him in a few days so we'll find out more.

[Steve507]

I agree with Tall Allen re his PSA and wait 3 months to test at this point.

I'm now PSA at 0.04 after 20 months since my RP. With

With his G 3+4 and 2 cores involved, there is every reason to be very optimistic about his future and a high quality if life for the next 15 years.

[piousheart in reply to Steve507]

Thanks a lot. Happy to hear your numbers are also in a good place. Wishing you good health.

[Justfor_]

0.028/0.017=1.65, aka 0.022 +/-28%

The max permissible error of the test is 20%, in accordance to its approval issued by the regulatory authority (FDA in the USA). Otherwise, they are not allowed to report 3 decimal figures and should revert to just 2.

Consequently, there is a small increase, but this should not worry you the least. Firstly, a sensible lower cut-off value is >0.06 and secondly it is the rate of rise and not the absolute value that rings the bells. If you want to monitor the latter, (rate of rise) monthly tests can give you an earlier and more reliable picture. You have missed the first test taken 4-6 weeks after the procedure. You would had got a better picture today if your dad had taken it. Think about it.

[piousheart in reply to Justfor_]

We had the first test done at 7 weeks and the next one roughly 4 weeks after. But I agree, it’s better to wait for some more tests to get a better idea. Hoping and praying the numbers continue to stay low 🙏

[Justfor_ in reply to piousheart]

When you have your next PSA test you may send me the outcome and I will give you some feedback. I am a retired engineer and have lived with numbers all along my professional life.

[piousheart in reply to Justfor_]

Thank you very much for your kind offer. I’ll make sure to share the next numbers with you.

[Steve507]

Until 0.1, it's merely Persistent Stress Anxiety (PSA).

[piousheart in reply to Steve507]

Thank you for helping us be more relieved.