Nerve Sparing and PSA

I know the post op PSA topic has been talked about here many times. However when it "hits home" it takes on even more urgency. My details are below but as a summary, I had my surgery in 3/08. My recovery has been nothing short of amazing. I am continent, erections are as good as pre op as well as orgasms. Except for the lack of the "fluid", all is normal. My PSAs have been .04 until my last which was .06. Still in the zero range but the rise concerned me. My Uro said it can fluctuate some. I did have sex the day before the test which I am not sure if this would affect my PSA. I had read somewhere that when the nerves are spared there can still be some PSA present. Has anyone else heard of this? Perhaps I should not be so anxious about my PSA but I am. Any input is appreciated.

Hello Bob D,   Perhaps you missed it, but just yesterday another HW member (41diagnosed) posted an almost identical question about the presence and fluctuation of very low levels of PSA .     As you hopefully know, there is no such thing as “zero” PSA in a living, breathing male.   The notion of a “zero club” is somewhat of a misnomer, which causes anxiety in some men when their PSA is reported at something other that “zero”, and especially when some variation exists.   Nerve-sparing RP is probably the best known and most significant source of PSA for surgical PC patients with no prostate.   I’ve copied/pasted the bulk of my informative reply to 41diagnosed’s question (posted yesterday morning) here:   Some surgeons specifically tell their patients to get only the “standard” PSA test after surgery specifically to avoid what is called “ PSA Anxiety.”   As you have already pointed out, Dr Catalona is (in your words) “dismissive of anything below .1.”   Why is this?   One reason is that unilateral or bilateral nerve-sparing surgery will leave benign tissue behind which produces PSA at a level detectable by the “ultra-sensitive” PSA tests. (reference:   http://www.prostate-cancer.org/education/preclin/McDermed_Using_PSA_Intelligently2.html )   Additionally, there is also normal day-to-day variation of PSA results which are evident only with the detection levels of the “ultra-sensitive” PSA test.   This article “The Downside of Ultra-Sensitive Tests” reports normal variation within the range of what you are seeing: (reference:   http://www.phoenix5.org/Basics/psaPostSurgery.html )   The concluding sentence in the article reads: ''It's important that we don't assume anything or take action on a very low level of PSA . In routine practice, because of these analytical variations from day to day, if it's less than 0. 1, we assume it's the same as nondetectable...''         Or, to read 41diagnosed’s entire thread, go here:  https://www.healingwell.com/community/default.aspx?f=35&m=1724435     Hope this helps ease your mind...

Bob, you are still pulling a solid zero.

Bob,

Your story sounds very similar to mine.  There is no doubt in my mind that sex raises the psa level so I would abstain for four or five days before any psa test.  I elected to be very aggressive with my situation and only time will tell if that was the right decision.  As of now I have no ed or continence issues and the radiation appears to have done its job on the cancer. 

I am the type person that worries too much so that is what drove me to do whatever I could do stop dancing with the PSA bear, hopefully I won't have to dance again and neither will you.

Good luck!

I know statistically you guys are right. I also know that sometimes there is residual prostate tissue that is not removed during the surgery, and may be able to produce small amounts PSA.

All that being said, if there was no value in knowing PSA to the .01, I doubt there would be any reason to do those tests. It is easy for us to say, don't worry, it's less than .1. Since .5 is commonly acknowledged here as the decision point for reoccurence, why not say less than .5 is zero, or of no consequence?

I agree there is no reason to take any action. But, in my own PSA's, I am certainly going to look carefully at the next PSA is 90 days. What I am looking for is a trend. I have decided that 3 increases in PSA, no matter whether it is .01 increments or .1 increments, I say a trend is a trend.

I guess what I'm saying is that I think we are a little too quick to dismiss these small increases. I know that in a large number of cases, they do go back down. I still say it is like a yellow warning light on the dash. It goes off for a reason.

goodlife and 41diagnosed, I wanted to share this insight (with you, and others who may follow this thread in the future seeking similar information) before this thread disappeared off the page.   You guys each mentioned different thresholds for BCR, biochemical recurrence…goodlife mentioned that 0.5 ng/mL is “commonly acknowledged”, and 41diagnosed mentioned the “magic number for being considered a recurrence” is 01/ ng/mL . While it is true that any doctor (or any patient, like yourselves) may use any threshold that they wish in order to declare a biochemical recurrence after radical prostatectomy, there IS an “industry standard” that exists.   The vast majority of practitioners have adopted this standard for uniformity, but one can still find (mostly in the older studies) various other levels referenced...you have pointed out several. The “industry standard” I refer to is in the American Urological Association’s   (AUA) “ Prostate-Specific Antigen Best Practice Statement:   2009 Update ” which is available free online.   The AUA serves as a medical specialty “support system”, working to ensure that it’s members are current on the latest research and practices in urology through various means, including “Best Practice” updates such as this.   There is no AUA enforcement mechanism, however, and so members are free to use and interpret as they see fit.   I find that being an empowered patient means keeping myself abreast of the latest & greatest which is published in industry-recognized documents such as this. The Guideline says the following with regard to reporting biochemical relapse of PC after RP on page 38: The AUA defines biochemical recurrence as an initial PSA value ≥0.2 ng/mL followed by a subsequent confirmatory PSA value ≥0.2 ng/mL .   The AUA PSA Guideline is available free online at: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf Post Edited (Casey59) : 2/24/2010 7:55:11 AM (GMT-7)