PSA value increase after 11 years aft... - Prostate Cancer N...

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PSA value increase after 11 years after a prosectamy

Dad was diagnosed with prostate cancer 11 years ago, got a prosectamy than, has been 0.0001 at the lab for the past 11 years, he just received a .01 on his test, I know we have to keep testing much more frequently now, but jeez is it coming back. We are scared

8 Replies

All of those are zero. He should not be getting a test that supersensitive- it picks up non-prostatic sources of PSA. Switch to a test whose lowest value is 0.1.

I would not worry at this point. The insignificant rise could be due to an irritation or inflammation in the prostate bed

Probably a change in analyzer equipment. For a two decimal digits reporting scheme things start having meaning above 0.06 where the quantisation error becomes inferior to the measurement accuracy.

There's a reason they call the results from ultra-sensitive PSA tests "noise"... Those extra digits cause so much unneeded anxiety to patients already anxious over their condition.

And even if PSA begins to rise, as noted, there not much to do but scan and see what's causing it at first. And those tests aren't proficient until a PSA rise to .5ng and better above, really .8ng is better (PSMA). And even then, depending upon the findings, would then provide a glimpse at the proper path.

11 years for a PSA blip isn't necessarily a bad thing either. All dependant upon PSA Doubling Time... You leave much out, age, general health, original staging and diagnosis, etc. But for now, it's certainly not time to over react or make a mistake and do anything rash.

Best Regards

I suggest asking your Dad's doctor whether they have changed the laboratory or method used to analyze your Dad's samples for PSA.

One key detail that might help understand what has happened: Was the most recent result reported as "0.01" or as "<0.01"? The "<", denotes "less than" and would indicate that the concentration of PSA in the sample was below the "limit of detection", a.k.a. "LOD" of 0.01 ng/ml for the analytical method, equipment, reagents, etc. used in the lab that analyzed the sample.

It appears that these days <0.01 is the most typical limit of detection for "ultra-sensitive" PSA analysis, although the lab used for my samples has been reporting <0.014 ng/ml.

Presumably the "0.0001" previous results that you referred to would actually have been reported by the laboratory as "<0.0001", because it seems unlikely that "exactly" 0.0001 ng/ml was detected in each of the previous samples. Apparently those results were obtained using an analytical method and equipment capable of still lower limit of detection. I have read articles reporting such lower LOD, such as the Quanterix AccuPSA method. However, it appears that the medical community has concluded that ~0.01 limit of detection is adequate for monitoring PSA following prostatectomy, considering that it appears that the trigger point for treatment of recurrence of prostate cancer following prostatectomy is now PSA of 0.1:

"... 0.2 is no longer the benchmark. Things have changed because of the presentation of data from the RADICALS randomized clinical trial in October 2019. It found that 3 consecutive uPSA rises or a PSA of 0.1 is as good as immediate (adjuvant) radiation."

URL for the above:

So, a change in the analysis used for your Dad's samples from "<0.0001" to "<0.01" would be consistent with phasing out of testing for PSA at limit of detection lower than 0.01 ug/ml.

Best wishes for a good resolution!

I would like to thank you all for the replies, just some updated information the test was 0.0001 never was the values only read up to 0.00, that being said 8/27/2020and every year prior, it was 0.00 until 8/10/2021 when it was 0.01. The testing system is Beckham coulter access II IMMUNOASSAY SYSTEM. I know you guys gave me the best answer u could give, maybe this would give some more insight? All his blood work is good just pre diabetic which is not good I know. Just the values have gone up we will check in 6 months

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Google search returned this FDA document:

stating that the lowest PSA detection level of a properly calibrated such analyzer is 0.008. Lesser values should be reported as <0.008. Past reports down to 0.0001 are either originating from another analyzer (very doubtful as -to my knowledge- there is only one that can that can accomplish it, yet, it has not been a market success) or they were just thin air!

The risk of recurrence is inversely related to the recurrence-free interval after radical prostatectomy. Wow, 11 years of undetectable PSA (<0.1), then the risk of the cancer coming back is almost zero.I will discontinue my annual PSA testing after 10 years. Maybe your dad can do it too?

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