PSA - CONFUSED

Perhaps you've seen talk here at HW/PC about the "Zero Club" which may, unfortunately, be adding to your confusion.  The "Zero Club" is a misnomer which can causes unnecessary anxiety and/or disappointment in some patients (perhaps like you) whose expectation is that after radical treatment for PC their PSA will truly be "zero", and their results come back at something greater than zero.

A couple things to note:

1. After a radical prostatectomy, a patient continues to have PSA testing to see if prostate cancer cells were left behind or spread.  PC cells outside the prostate (if present) will continue to produce PSA in the bloodstream.  Continuously and consistently low levels (or undetectible levels) of PSA indicate that the surgery has likely "cured" the prostate cancer (in other words, that the cancer was truly "organ-contained, and the organ with all the cancer has been removed).  Similarly, if one chooses radiation therapy as first-line treatment (or has radiation as a secondary treatment), ongoing PSA tests measure the effectiveness of cure.
2. As previously clarified "zero" PSA is a misnomer.  Every living, breathing man with or without a prostate has some level of PSA in his bloodstream.  There are different measurement technologies which are accurate to different levels of detection.  For men in the low risk category before surgery who end up with no extraprostatic extension and negative surgical margins, most commonly their doctors will prescribe the "standard" PSA test with lower detection limits (LDL) down to 0.1 ng/mL.  In cases that should be watched more closely, there is an "ultra-sensitive" PSA test (most commonly with one more digit of significance).
3. The American Urological Association (AUA) has defined biochemical recurrence as an initial PSA value equal to or greater than 0.2 ng/mL followed by a subsequent confirmatory PSA value also at equal to or greater than 0.2 ng/mL.

Due to your heightened interest in PSA, I recommend visiting this link to the AUA's free online document "Prostate-Specific Antigen Best Practice Statement:  2009 Update."  Go here: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf

 PSA values in ng/mL usually in US, but this is equivalent to the SI units of mcg/L; that is, 4 ng/mL = 4mcg/L

You might ask for a hard copy of the report and clarify the units

 and if there was a " < " in there. The nurse probably does need to get educated, there is no zero

Congrats!

On my 6 month PSA test the URO's nurse called me with my results and she told me my PSA was undetectable but I still had to ask how sensitive their testing equipment was and she said down to 0.04. So I list me PSA as <0.04. My first 3 month post PSA was on equipment that measured to 0.07.

Terry