Help: Ultra sensitive PSA test anxiety

For starters, never heard of a verified .0 reading. Most tests can not register that low, there is always some "noise" in the reading, and there is always a +/- tolerance in the test. To have a reading at .02 is very, very, very good. Couldn't imagine any reason to worry or think anything is wrong. The real goal is to stay <.10, you are at 20% or less of that benchmark.

I would suggest to put this worry/anxiety behind you, and celebrate your good fortune. You are doing great, now you need to convince your mind the same truth.

david in sc

Hello: Important..check out the notes at the bottom of the report from the lab. Several months ago one of the main labs doing the Ultrasensitive test stated that they no longer state < 0.01 and now use < 0.02 as the lowest limit. Had I not have known this from reading it on this forum prior, I may have been worried. Again, get the report and read it carefully. Also, it is amazing how many nurses or healthcare workers either don't care about the"<" symbol or worse on't even know what it is! Your PSA was close to mine (3.3) and if you were a Gleason 6, you could relax. You have very little chance of BCR in my opinion. But this is one of the drawbacks of the Ultrasensitive test.

There are two reasons to relax: the first having to do with biology the second having to do with the lab instrument.

Biologically, there is day-to-day variation in your body, and there are also tissues that can generate very minute amounts of PSA even though your prostate is gone. Right after the surgery these may not have much blood supply, but as blood vessels re-connect you can start to see very low levels of PSA like this. According to one study unless you get three consecutive rises on an ultrasensitive test you should not be thinking about it as a potential recurrence. Note the word consecutive in that sentence.

Technically, all tests have some "noise" in the result. If the test has a lowest reading of less than .01 then the last digit .01 should be considered as the margin of error. So your first test result was really "<.01 plus or minus a possible error of .01" and the more recent test was ".02, plus or minus a possible error of .01." So you can see that these two results are not really much different.

Many people have psas's that bounce around for years less than .1 and never progress beyond that. That is why the guidelines say not to make decisions on salvage radiation until at least that level, in most cases higher.

So go out and celebrate!

I'm not sure of the point of ultra sensitive testing either.
My lab now does ultra-sensitive tests, but only because the older, less sensitive machine had to be replaced. The uro said their thinking about when to act is based on the 0.2 threshold. And both the uro and RT doc said that they are concerned that small fluctations near the very bottom can make guys worry too much when they don't need to.

It seems to me it's a bit like having a clinical thermometer that (unnecessarily) reads to several decimals, as what you need to know is do you or do you not have a fever and is the temp going up or down, and you can do that adequately with one decimal.

However I expect I want to have it both ways, because while I am currently "less than 0.01", I bet I will panic when/if they tell me one day that it is now "0.01" or "0.02"!!

Alf

RH1970,

What was the result of your biopsy and what is your gleason?

A gleason 6 might look at PSA tests a bit different than say a gleason 9.

Jerry L.

I've a friend in the lab at the clinic I use. He tells me that they have been doing ultra sensitive tests there but the uros, concerned about test anxiety, typically get the results truncated to one decimal place. I got 0.02 results this last test because of newer equipment and I could tell my radiation oncologist was all set to calm me down. However, largely because of this forum I was doing back flips instead. My lab friend tells me there's a push for one decimal place going on behind the scene.

Knowledge is power even if you don't like how the results look. I'll always take as many digits as I can get. I want to be the one to decide how they get rounded.

Be a careful about the Walsh bible book. It wa originally written in 2001 and has 3 editions. 2001, 2007, 2012 . PSA testing has comea long way since 2001.

I was a participant in a study that compared two diagnostic test methods to 2 decimal digits: the older ultra sensitive 2 decimal test, Siemens Centaur - June 2006 protocol, and the new, more selective method Roche Cobas 601 - April 2010 protocol. All samples were drawn the same day from the same vial.

Here is my data after RP in July 2009.

As you can see the older method reports a slightly higher value and my results are quite stable.

1/14/2010 6 mon. - 0.05 (Siemens Centaur)
4/14/2010 9 mon. - 0.04 (Siemens Centaur) and <0.01 (Roche ECLIA).
7/12/2010 1 year - 0.03 (Siemens Centaur, direct chemilum); <0.01 (Roche Cobas 601 ECLIA)
10/22/2010 15 mon.- 0.03 (Siemens Centaur, direct chemi.); <0.01 (Roche Cobas 601 ECLIA)
12/29/2010 17 months Siemens data discontinued; <0.01 (Roche Cobas 601 ECLIA)
All PSA test since then have been ,<0.01, except for the latest one at 3 years where the lab changed their reporting to and now use <0.02 as their minimum value.

the Roche Cobas 601 actually reports a resolution of 0.003. That is why some guys will get a report that says 0.003 or 0.006 or 0.009. The lab rounds it to <0.01.

So, does 0.02 make a difference? It depends upon the machine used. Ask for a copy of the report and find out what machine and protocol was used. You want the same lab using the same equipment.

And you should be consistent too.
Good luck,
Jeff

Thanks everyone for your reassurance. I definitely feel better. I suppose as some time passes, the anxiety will fade. As long as relative ease doesn't slip into complacency, I'll be OK.

My Uro has ordered another test in 6 months. Since I didn't show any EPE, SV or lymph node involvement, I guess he feels more frequent tests are not necessary.

It is curious that my first test results showed a 0.0. I think I will call the lab and ask about what exactly that 0.0 means and what the lowest sensitivity of the test is. And if the lowest sensitivity of the test is .01, then does that mean that the test has a margin of error of +/- .01?

Thanks again for your support.

Post Edited (RH1970) : 11/17/2012 7:30:46 AM (GMT-7)