Persistent PSA

A very dear friend was diagnosed 9 yrs ago and had surgery. Unfortunately he had BCR within a year and underwent salvage radiation. PSA after salvage never went back down but grew to about 1 within a year. However, surprisingly it has been at 1 for the past 7 yrs. His doctor was puzzled but told him to enjoy his good fortune. So, this is probably considered persistent PSA. No one knows how long things will stay that way but I assume his doctor will watch things carefully.

I would seem to fit into this definition to a T. My first PSA after surgery was .4 and then the rest is history. Upon completing RT, just 3 months after surgery, my PSA was 1.0 and it has been steadily going up since. My most recent PSA, March 2011 was 4.2.

I had MET radiation 10 months following surgery.

This is the answer my doc has been giving me each time we meet. I just seem to have enough cancer cells running around in my body to generate the PSA, but I am not feeling any effects from it at this point. We are doing another Bone Scan/Survey in May to see if there are any changes since my last one May 2010. This is when we found the MET.

Thanks for posting this. Gives my doc a little more credence with me.

Sonny

I understand that in some cases some benign prostate tissue can be left behind and result in a post surgery PSA reading. This is why docs want to see consecutive increases in PSA before calling it a BCR.

I can see how the discussion on this blog can get a little confusing for many men.   The Prostate Doc has attempted to write a brief overview that provides a very basic level of understanding, and he (probably appropriately) avoids too many details which, in reality, makes the simplistic perspective too complex for a short blog intended for a general audience.   I’m not saying that the Prostate Doc doesn’t understand these differences (because of course I think he does understand them), I’m just saying he’s simplified things for the sake of a general audience. The reality is that there have been many discussions here at HW which have been more in-depth than this high-level blog, and so many readers here will recognize the blog shortcomings.   I think the blog does provide a decent overview for men who know just-a-little about PSA after surgery…which is a lot of guys.   Not everyone wants to get into the hairy details, and not everyone needs to, and the target audience for this blog was not those with considerable patient knowledge of PSA and PSA testing.   You’ll notice that the Prostate Doc does make mention of the ultrasensitive PSA test down at the end of his 3re paragraph, “ With the advent of ultrasensitive PSA… ”, so it is important to realize that everything above there is talking only about the standard PSA test (lower detection limit of 0.1ng/mL).   The comment made by BB_Fan is exactly correct, that some benign prostate tissue left behind, especially after nerve-sparing surgery, can frequently be detected… with the ultrasensitive test down to a lower detection limit of 0.01ng/mL (typically).  This is the original use of the term "PSA Anxiety" for guys getting the ultrasensitive test and seeing the naturally occuring variation of benign tissue.  The standard test won't pick-up benign traces because it is almost always below the standard test lower detection limit. If PSA is detected with the standard test after RP, this is a typical indicator of systemic (persistent) prostate cancer.   If there were only local PC left in the prostate bed after surgery (not systemic mets), then the PSA would typically (not always) be initially below the standard test detection limit, but increase over time to become detectable. Many here have been getting the ultrasensitive PSA test, and it is often prescribed if there are unfavorable pathology outcomes or high clinical risk cases…but these situations are not covered in the Prostate Doc’s blog. I hope this helps clarify… Post Edited (Casey59) : 4/7/2011 8:04:28 PM (GMT-6)

Hope 1 said...
I have always understood there is no such thing as zero PSA and any reading under .1
is undetectable.
Hope 1.

Hope 1,

At a high-level, this is also pretty much what Prostate Doc is telling you.  That's usually enough information for the general population.  If you want to know more, then read on...but if that's enough information for you, then stop here.

There are now two types of PSA tests:  the "standard" PSA test, and the newer "ultrasensitive" PSA test.

The "standard" test has a lower detection limit of 0.1 ng/mL, so if (as you said) a reading is less than that threshold, it is reported as "undetectable."  There really is no such thing, also as you noted, as zero PSA in a living breathing man even after RP, but the amount of PSA may be so low that it is undetectable in the "standard" test. 

The "ultrasensitive" test typically goes down to a lower threshold of 0.01ng/mL (or a little higher, or lower; there are several types of ultrasensitive tests, but this is the most common one).  After RP, there may be trace amounts of benign tissue left behind from the prostate that still gives off trace amounts of PSA which MAY be measurable with the ultrasensitive test.  This is certainly a detectable amount using the ultrasensitive test, but would have probably been undetectable using the standard test.

Hope this further explains...if you wanted that additional info.

casey, thanks for the further explanation.

hope, your statement is generally accepted the way you stated it there is no such thing as a .0 or a point .00 or even a point .000 reading, depending on the test assay. most consider anything <.1 as been undectable. here on hw, when we refer to the zero club, we don't mean a literal zero reading, its a phrase we use to celebrate someone's reading below that .1 mark. so your thinking is correct.

daslink: good luck on your may psa reading, my next one will be at the end of may

fairwind, let's hope not, as that would be a major forumn rules violation if someone had multiple accounts or identity here on HW