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Posted 6/29/2011 1:58 PM (GMT 0)
As I reported a few weeks ago, my first post op PSA was supposedly .13. I was somewhat concerned by this report since I had hoped to be a quick member of the zero club. I had my 3 month post op appointment with my surgeon on 6/15. He was not concerned at all, and the lab had not forwarded him the results,  although there is nothing he could suggest anyway. He is a surgeon, and he informed me he was releasing me from his care.

    After demanding a copy of the report, I saw that the result was not .13, but <.13. The lab at my local hospital said on the report that some federal guideline did not require any report below .13 even though the test measured to .05. All results less than .13 would be designated <.13. What a bunch of crap.

Posted 6/29/2011 2:21 PM (GMT 0)
So for all intents and purposes the < makes you "undetectable".

I'll wave at you from outside the zero club bar. Maybe I'll be back some day.

Posted 6/29/2011 2:29 PM (GMT 0)
BTW - never heard of any "federal guideline" that controls the results of a psa test. My labs report what they find, and it does vary, but based on the type of test and equipment.

I suspect someone was inventing a reason -

Posted 6/29/2011 2:39 PM (GMT 0)
If that were my report, I would start making calls to find another lab that reports the numbers correctly. Devote one hour to finding a knowledgeable, competent lab. Call the university hospital nearby and ask. Call your urologists office and ask. Then call the lab and ask what kind of equipment they use and the minimum resolution.
I am not sure who told you your original number but if someone in the Uro's office does not know the difference between "0.13" and "<0.13 where 0.13 is the minimum" then I would start looking for someone else for followup.

You are starting on the long road of regular PSA testing and you need to get results from a lab you can trust. Your diagnosis (and mental health) depends upon it.

Good luck to you.
Jeff
Please see this thread. I mention the results of a study I participate in. Siemens (2006) vs Roche (2010) equipment.
Posted 6/29/2011 3:00 PM (GMT 0)
It looks to me like the "ultra-sensitive" test is just too variable in the results produced, meaningless fractions extended out one to many decimal points to provide any useful information...

My last two tests came back <0.1 - undetectable. That's good enough. (in my opinion). Taking it out another decimal point only creates a lot of additional worry which in most cases is not actionable...

"He is a surgeon, and he informed me he was releasing me from his care. "

That sentence is more telling than the PSA test result...
Posted 6/29/2011 3:14 PM (GMT 0)
This sounds fishy to me. There aren't any federal guidelines regarding PSA results posting like this.  If the instrument's lower detection limit is 0.05, and it's been calibrated and tested for precision and reproducibility, then they should report results as such, for example, <0.05.

I agree with Fairwind that there is a lot of variability (background noise) with the ultrasensitive tests.  The old standard <0.1 is good enough for me.

Posted 6/29/2011 3:39 PM (GMT 0)

I thought < was an indication that the number that followed was as low as the lab could test.

What they're telling you is inconsistent.

Posted 6/29/2011 4:16 PM (GMT 0)
Dave,

You should be correct - the < should depend on the equipment and the test being used. The idea of only reporting down to a certain level even if the combined equipment/test reported a lower number seems to be constructed by the physician or the lab.

This goes back to the old "ultrasensitive creates unneeded anxiety" routine that my uro uses. But now that mine has topped .2, they are again paying attention.

Since I am still wet, and ED is complete, I wonder what improvement in QOL I would have gotten by not knowing my PSA was on the rise? Soggy, limp, and demoralized vs. soggy, limp, demoralized, and concerned. Humm ........

Posted 6/29/2011 10:08 PM (GMT 0)
Once again this is another example of why you should always demand that any report of any kind be given to you.  I have had the same thing happen to me with my GP.  They left off the < when they read it to me over the phone.  Always get a copy of your lab results from everyone for anything.  This would have prevented you a lot of anexity.....
Posted 6/29/2011 11:58 PM (GMT 0)
Fairwind. How would you have felt if the number they gave you was "0.13"?
That is very different from "< 0.13, the minimum value we report".

That is a huge difference and does not instill confidence in the staff's understanding of the numbers.
If this was reported by an Orthopedic office I can understand their not understanding. But if this is a Uro's office. Shame on them.
Jeff
Posted 6/30/2011 2:32 AM (GMT 0)
"discharged" by your uro at three months? I haven't seen such a thing. I'm past two years and my uro is still monitoring me every 6 months.

You should consider finding a new doctor.
Posted 6/30/2011 3:09 AM (GMT 0)
geezer,

I read that the surgeon, not the uro, dismissed him. I understand that is normal. My RO passed me back to the uro at one month out from the end of RT.

In my case the uro was the surgeon, so that relationship remains the same.

Posted 6/30/2011 10:06 AM (GMT 0)
My uro only uses Bostwick for PSA tests (and biopsies).   I get a composite graph with every test that shows all my PSA history and I know there is consistency in the tests.   Currently we are not using the ultrasensitive test.
Posted 6/30/2011 12:53 PM (GMT 0)
On my 2nd psa test (post surgery) the nurse read my result and forgot to mention the < sign also! I was beyond freaking until I saw the doctor. He told me that is why he doesn't like his patients calling in for the result due to human error. The last two times I've had my tests I've waited to get the results from the Doctors own words.

lewvino
Posted 6/30/2011 5:00 PM (GMT 0)
 

Low and slow it is a bunch of crap.

Stop going to the surgeon, why are you still following up with him.

No more to him.....go back to your urologist and follow up from there. 

Your numbers are good.  When its gets to 0.2 you'll have to probably see the radiation oncologist, but stop seeing the surgeon for follow up with him, what for? 

Posted 6/30/2011 6:07 PM (GMT 0)
I've mentioned this before. When the doc gives you the blood request form make sure the CC box has your name in it with "(PT)" next to it. You will get the report mailed to you directly! That way you do not have to worry about an incompetent reading the numbers incorrectly. If the staff does not know the difference between 0.2 and 0.02 they should be fired.

Don't leave the office without demanding to get a copy of the report for your records.

Jeff
Posted 6/30/2011 6:20 PM (GMT 0)
Like Chris, I always get a copy of every report.  Many health care workers (including nurses) don't understand the symbols used for less than (<) and greater than (>).  For this reason the Institute for Safe Medication Practices recommends that the symbols not be used.  Labs still use them, assuming those reading them know what they mean.
Posted 6/30/2011 9:37 PM (GMT 0)
Lowandslow, that is why I stopped going to my local uro who did the dx but not the RRP. He does the 0.1 minimum  test. He does this because, he says, noise, bla, bla. He really does this non sensitive test because that is the test equipment they have at their office and they do this in house and it is fine for dx'ing PCa, not so good after, until it's too late. Then oops's. I go to my GP who sends this out as he sends out all his blood work. What do you need a uro for, unless you are having some issues, all they are doing now is reading the psa test. I can do this and certainly my GP can. My ex-local uro also told me how horrible the RRP was ( he does (or did) the open), said it would be maybe 8+ hours on the table, it was less than 2! Now that there is finally a daVinci town, I wonder what he says now?

And about the <0.13 you got, all that means is you are less than 0.13 and that does not but you in the zero club! you could be 0.129!. I am not trying to be unsuportive, but like others have said, you need better than you are getting. I would guess that you really are in the zero club but why not get the peace of mind to know one way or the other.

Ron

Posted 7/17/2011 1:57 AM (GMT 0)

Sorry I haven't posted a reply, but I had an angiogram and needed another stent, so I've been dealing with that. I had two heart attacks at age 40 and was feeling a little wierd in the chest area. Sure enough, that old problem reminded me it wanted some attention.
To clarify, the whole federal guideline bit was actually printed on the report, not just a statement by a lab tech or rep.
The surgeon declared me "cured" and wrote a "graduation" letter sending me back to my local uro. I can actually see the logic in this because although this surgeon has literally done thousands of this procedure,(RRP) it makes him little more than a line mechanic. The procedure itself is almost all he does.
My local GP ordered the first PSA test. My local uro and gp use the same lab, my local hospital lab. Rural area and all. I spoke with my local uro on 7/13 and have decided to just keep doing things locally. If my psa goes over .14, I will schedule with the Barret cancer center in Cincinnati for radiation. I may be fooling myself, but any extra time healing and recovering continence is well worth not knowing the difference in a rise in psa up to .14.
Maybe I'll get lucky and just die of a heart attack anyway. It was first in line.

Post Edited (lowandslow) : 7/16/2011 8:01:25 PM (GMT-6)

Posted 7/17/2011 2:32 PM (GMT 0)
You can't do any better than the Barrett Center. Right now my RO is in Blue Ash, but if I need an oncologist,that's were I'm going.
My surgeon is kind of a stick in the mud,but other uros I've seen in his group have been just fine. My uro does his PSA testing in house.
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