PSA Testing (Ultra sensitive)

I'm aware there are reasons to not test your psa post operatively using the Ultra sensitive method. I want to share my experience having done it. 5 years ago this April I had robotic surgery to remove my prostate. My psa was 4.1 and the biopsy indicated Gleason 6. Post surgery it was upgraded to Gleason 7 3/4. It had extra capular extension but there were no positive margins. For the first 4 years that I tested my psa using the ultra sensitive method my psa ranged from .023 to .037. Then at the 4 year point my psa tested at .05 and I did it two more times once using a different lab and they both came back .04. I went to my urologist and he recommended I see a radiologist and get prepared for doing radiation when it rose over .1 or .2. My wife and I visited the radiologist and of course the whole experience of talking about the treatments was somewhat upsetting. 3 months later I get my PSA tested again to see if it had risen much from .04/.05 to sort of judge how long I had before radiation and I was surprised to see my PSA was back down to .023, waited another 3 months and it was .023 again. The doctors have no explanation of why this happened but if I hadn't been doing the ultra sensitive test that little experience would have been avoided because I would not have known since it doesn't look at anything under .1 When my psa had gone to the .04 and .05 area I tested it several times as I indicated with different labs so it was actually up for that brief period of time. I was wondering if anyone had any comments about this.

Well there are two lines of thought with this and I suppose it depends on your personality. I think you will find that the analytical/engineering type fellas will opt for ultrasensitive over standard. When I had my op I wanted to know if the operation had been successful or not. PSA tests to the standard level i.e <0.1 are not really indicative as to whether a cure has been effected ------ ultrasensitive to the third decimal point is a great pointer if it is in the less than 0.01 region (as is a consistent and relatively unchanging very low PSA. Should a relapse occur from such a low base you can have as much as 2 years prior notice that additional salvage treatment may be in store.
Some people may not want to know till relapse becomes apparent by the PSA exceeding 0.1 and climbing. Of course all this can be further complicated by residual benign tissue left as a result of nerve sparing. It just depends on how one approaches problems.
Bill

Post Edited (BillyMac) : 3/12/2013 8:09:13 PM (GMT-6)

Rusty,

We had the reverse . After having been on HT for 1 year and having TRADITIONAL PSA's, our local prostate group encouraged us to have an ULTRASENSITIVE PSA.

We did so and my husbands reading was <0.1 with TRADITIONAL and 0.1 with ULTRASENSITIVE We also changed Dr's.as our Urologist  didn't think it was necessary to do ultra PSA'. We then found a new Oncologists and he agreed doing an ultra test is unnecessary. We then went back and had another traditional PSA and it came back <0.1

 

Dr agreed let us have a HT holiday for now. My husband's PSA will be rechecked in April, and quarterley until or unless it starts to rise.

To sum up our Oncol.said Ultra tests are too much info! We are back to traditional ones.

BOOGEE

 

I think you could be right BB Fan.

An ultra sensitive test post op will not tell you that the cancer is cured any more or less than std. At this point in time, nothing will. Rusty your point is the crux of the ultra/ std conundrum.

logoslidat said...
An ultra sensitive test post op will not tell you that the cancer is cured any more or less than std. At this point in time, nothing will. Rusty your point is the crux of the ultra/ std conundrum.

I disagree logoisdat. PSA below 0.1 could be anything from 0 to 0.099. The aim of a prostatectomy is to remove the prostate and all tumour which will result in essentially zero PSA. Residual microscopic tumour (either local or metastatic) will not produce detectable PSA, even at the ultrasensitive level. However as the cells divide and double in number the PSA will inexorably creep upwards reflecting the number of tumour cells present. This is why the doubling time of PSA is so important ------ it is a great indicator of how fast the tumour cells are dividing i.e. the cancer is growing. Tumour cells left following surgery and tested for via the standard PSA test may well be growing for two years (and sometimes slower) before the presence of residual tumour is detected via a PSA reading exceeding 0.1. Testing at the ultrasensitive level will reveal this growth at a far earlier stage

From the article below:
Chi-square analysis demonstrated that men with a PSA nadir of less than 0.01 ng/ml had a significantly lower rate of biochemical relapse than men with a nadir of 0.01 ng/ml (p 0.01), 0.02 ng/ml (p 0.025) and 0.04 ng/ml (p 0.01). There was no significant difference in relapse prevalence between the PSA nadir 0.01 and 0.02 ng/ml groups but the relapse prevalence in these 2 groups was significantly smaller compared to that in the 0.04 ng/ml or greater nadir group (each p 0.01).

webdoc.nyumc.org/nyumc/files/urology/attachments/shen_lepor_taneja.pdf

But as I said the whole issue can be clouded by residual benign tissue in which case you want the PSA to remain static over the long haul.

I guess one's preference boils down to:
Personality A ------- I want to know what's happening
or
Personality B ------- I don't want to know till it happens

In Rusty's case it would appear at first glance that residual benign prostate tissue (usually as a result of nerve sparing surgery) was left at the time of his op, giving him a PSA reading (at very low but relatively static levels)
Bill

Post Edited (BillyMac) : 3/12/2013 10:00:58 PM (GMT-6)

Hi BillyMac,
I am the analytical type person and I feel more comfortable if I know what's happening. I am also having ultrasensitive PSA tests and recent ones are at 0.003 ng/ml. My question is does it ever go below that level? Can it be 0.000?
thanks and take care
Traveller58

BillyMac said...
Well there are two lines of thought with this and I suppose it depends on your personality. I think you will find that the analytical/engineering type fellas will opt for ultrasensitive over standard. When I had my op I wanted to know if the operation had been successful or not. PSA tests to the standard level i.e <0.1 are not really indicative as to whether a cure has been effected ------ ultrasensitive to the third decimal point is a great pointer if it is in the less than 0.01 region (as is a consistent and relatively unchanging very low PSA. Should a relapse occur from such a low base you can have as much as 2 years prior notice that additional salvage treatment may be in store.
Some people may not want to know till relapse becomes apparent by the PSA exceeding 0.1 and climbing. Of course all this can be further complicated by residual benign tissue left as a result of nerve sparing. It just depends on how one approaches problems.
Bill

Hi BillyMac,
Thanks for the information, I really appreciate it. My PSA results during the first 3 months were 0.002 and 0.003. After that I was on hormones for 15 months (including the 3 months period following the last injection) and all PSA results were at 0.003. Then I received RT so I used all my cards for a curative treatment! Apparently HT was masking the PSA during that period. The PSA tests after this period which I assume I was not protected by HT were all 0.003 again. My last PSA test was 4.5 months after the HT period. Maybe it is a good idea to test the Testosterone level and see if it increased or not. I assume that if T level stays at very low levels your PSA will not increase even if you are not on hormones. What do you think?
All the best
Traveller

Post Edited (Traveller58) : 3/17/2013 5:52:48 AM (GMT-6)