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Posted 12/7/2013 10:19 AM (GMT 0)

With all the discussion about PSA testing (over use etc) I have questions about PSA test after surgery. Obviously recurrence will always be in the back of my mind and I want to be able to attack it ASAP if there is evidence cancer has returned.  My Uro told me I should not worry unless my PSA reaches .2. My PSA report always shows the result to one decimal point.  However some of you use the ultra-sensitive test that carries the decimal point out two and even three points.  I asked my Uro about it and he said the ultra-sensitive test causes unnecessary worrying and he does not recommend it.  So my question to those of you who use it is why?  Am I missing something?  Am I putting myself at risk by not using the more sensitive test?  My anxiety level about an upcoming PSA test is through the roof already.  If it is true that recurrence is not suspected until PSA reaches .2 then why raise my anxiety level even higher because my PSA test might rise from .01 to .05, for example?  Heck, I am already worried because my testing went from undetectable to .1 in three months.  I guess my biggest fear is waiting too long to attack recurrence if it happens.  I have always done what my doctors told me as far as testing is concerned (PSA and DRE) and yet my prostate cancer  was at an advanced stage when finally detected.  I don’t want to put myself in that position again if there is a test that can warn me sooner. 

Posted 12/7/2013 11:42 AM (GMT 0)
The lab that my URO uses always shows two decimal points.

And then there's the part about rounding... Is a .05 really .05 or is it .044 or .049 ....

I just go on the theory that there isn't anything I can do about the results except deal with them. No sense loosing any sleep over it.

If I were in your shoes and received a .2 - I'd wait another six months and get tested again before I made any sort of move.
Posted 12/7/2013 1:34 PM (GMT 0)
My husband's first post op PSA came back <.02 undetectable. He had another PSA test a month later and it came back <.1 - same lab. The first report called it a "post-prostatectomy PSA test" and the second did not. They were both done at the same lab, but blood sample had not been correctly labeled before going to lab - so they ran the wrong test. We're having it redone....our feeling is that it would be better to identify an upward trend very early in the game.
Posted 12/7/2013 1:53 PM (GMT 0)
My urologist said the same thing, that the ultra sensitive PSA test have jitters with readings that go up or down and can create anxiety for the patient. He said that the normal PSA test is fine and he want to see three consecutive increases and a value of 0.2 before jumping into any salvage therapy.
Posted 12/7/2013 2:43 PM (GMT 0)
Hello: Getting an ultra-sensitive test is beneficial in that it will show the true PSA "nadir" (lowest) number and that will give additional information as to what may happen next. Many papers have shown that men achieving nadir numbers as low as <0.01 have a lesser risk of recurrence. It may also alert the patient sooner of a recurrence and many doctors believe that the sooner this is recognized and treated, the better the outcome.

But as many have stated, the ultra-sensitive test does cause worry in that the normal variation does "bounce" (and it is clearly seen with these tiny numbers) and that may incorrectly lead the paitient to assume that he is experiencing a recurrance. So it is a double-edged sword.

Personally, I always get the ultra-sensitive test that reads to the hundreth. Luckily, mine have all been <0.01. But I do worry that "test noise" will at some point creep in and that will indeed upset me.

Your final decision may come down to "how much do you really want to know". Good luck.

Bill K. from NJ

Gleason 6, daVinci July 2011, no problems at all at 29 months post surgery.
Posted 12/7/2013 4:03 PM (GMT 0)
Thanks for the info. Gives me a lot to think about. While I want to know as early as possible if there is recurrence so I can act sooner, I don't know if I can handle the additional stress the ultra-sensitive test might bring. Seems like there are never any easy answers in this battle.
Posted 12/7/2013 4:34 PM (GMT 0)
I'm thinking a sensitive test offers an opportunity to spot a trend sooner. In terms of being an informed patient, I prefer a sensitive test. It has caused me a bit of drama though. Good luck.
Posted 12/7/2013 5:32 PM (GMT 0)
Ultra sensitive test can spot a reoccurrence up to 2 years sooner by seeing a rising trend in psa. I don't know of many patients who have acted upon this information as most wait until it reaches .2 for any salvage treatment.
The question that you have to ask yourself is: are you willing to act on three or more small consecutive rises in psa, knowing that psa could always stabilize before it reaches .2 or would you wait a little longer for it to reach .2?
Personally I would act if I had a G8 or a G9, wait until .2 if I had a G7. If I had a G6 I would definitely wait for a long time and make a salvage decision based on psa doubling time.
I have a philosophy of having aggressive treatments for aggressive cancers and acting less aggressively with less aggressive cancers.
Posted 12/7/2013 6:07 PM (GMT 0)
Thanks for the info. Gives me a lot to think about. While I want to know as early as possible if there is recurrence so I can act sooner, I don't know if I can handle the additional stress the ultra-sensitive test might bring.

well....you can't have it both ways.  me, I would be poised for radiation, have a trigger set,  and be doing ultra sensitive testing.  there's a narrow window when salvage treatment is most effective.  I see many guys miss that window either because of indecision, denial or a doctor dragging his feet.

you know what you want.

ed

 

Posted 12/7/2013 7:25 PM (GMT 0)
I was also advised to hang in there until PSA reaches .2 and not to worry about PSA reading to the  tenths vs the hundreds or thousands.  So that's what I'm doing. I see no reason to get antsy over movements of hundredths of a point! Bob ______________________________________________________________ DOB January 1944 1981: prostatitis 2000-2013 BPH, low T treated with avodart, tamsulosin, androgel PSA History: Pre 2000     0.4 2001-2009  0.6 11/2011      2.2  8/2012       2.7  2/2103       5.5  4/2013       6.1  5/2013       6.6   11/1 2013   0.1    6/2013 Bx:PCa Gleason 4+4=8 (Bostwick), 4+5= 9(Johns Hopkins), 2/6 cores, 10%, 40%,  DRE neg. (Stage PT1c)   7/2013: bone scan and pelvic MRI negative for mets.  9/7/13 open nerves  sparing RRP, Johns Hopkins, Ted Schaeffer MD PhD.  9/9/2013  Pathology: 33G, SVI, EPE and 4mm pos. margin at base (Gl7), (Stage PT3bN0M0)  9/20 2013 Foley and staples removed;   currently: one pad per day for security, ED (pre-op and post op) Watchful waiting until next PSA in 2 months
Posted 12/7/2013 9:10 PM (GMT 0)
Over the past three weeks or so I've participated in two other similar threads regarding ultra-sensitive vs standard PSA range. There seemed to be more positive input here for the ultra-sensitive route than I recall on the other two. Having said that and seen the arguments, I still don't think that I would be up to the added stress of the ultra-sensitive. In my own situation, I don't think I can deal well with so much information..but that's just me.
Posted 12/7/2013 9:38 PM (GMT 0)
Who says there is a narrow window other than some studies which usually includes nervous nellies who are already cured and skew the results that the small window is reliable when in fact it ain't. I say if you want the ultra get it. If you want the std , get it. But to believe that it makes any long term difference in a disease as complicated as PCA is just that, a belief and belief can make things change either positively or negatively….. If you don't believe that, then it probably wont't make a difference, hence our circular universe. Do what you will and Love….. Paraphrase, Augustine Bishop of Hippo, circa 300-400 C.E.
Posted 12/7/2013 10:10 PM (GMT 0)
I got your Hippo right here Logo cool ..........

http://erader.zenfolio.com/p880102965/e22694b46

Posted 12/8/2013 12:35 AM (GMT 0)
Thanks again everyone for your responses. All of you have educated me as to the plusses and minuses of each test and that is what I was looking for. Next test for me is February so I have a little time to decide which way I want to go.
Posted 12/8/2013 5:29 AM (GMT 0)
F8, that is a total laugh our loud, choke kine. I got laugh tears on that one.
Posted 12/8/2013 5:38 AM (GMT 0)
Bob: that's a much healthier attitude to take about testing. Too many guys drive themselves over microscopic movements with ultra sensitive testing. I agree with you completely.

David
Posted 12/8/2013 11:32 AM (GMT 0)
Bob and David, that is the one big concern I have had about the ultra-sensitive test. I have seen so many comments from people who were freaking out over a small change in their numbers and it was suggested the change could be "noise". I don't need the added stress the test results could bring and there is a possibility it is just "noise". But at the same time if so many people are using the test it made me wonder if I could be denying myself useful information. That is why I love this forum so much. Whether we agree or disagree on a topic, all of you are willing to share your experiences and knowledge so others can make an educated decision about which path to take. Thanks again everyone for sharing!
Jim
Posted 12/8/2013 4:16 PM (GMT 0)
They probably type it that way to eliminate anxiety. I'd prefer to see what the machine sees on this one, not what some one interprets. IF I were to use ultra sensitive, that is. Do folks, realize how little antigen .01 is, and to call .02 a doubling time is silly. Not that there's anything wrong with that….
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