another 0 but a question

Since it is bothering you (as it would me) just have a retest. I would also ask for an ultra sensitive test. Still one blood draw and you get 2 #'s back. 2 digit and 3 digit.

You will feel better. No need to be stressed at all.

Craig, the answer is: it depends.


If you had an unfavorable-risk case pre-surgery and/or unfavorable pathology after surgery, then you should have the "ultra-sensitive PSA test" regularly.


If you had a favorable-risk case before surgery and favorable pathology after surgery, there was no need to have gotten started with the ultra-sensitive PSA test because it brings no benefit and only unnecessary worry.


What was your situation?

This is an interesting thread; I have always assumed that the definition of undetectable was less than .01, and did not know there is an ultra sensitive test and a less sensitive test. My test results have always had two decimal places... Does that mean I am getting the ultra sensitive test?

My situation is similar to craig10's, except I have always used the same lab. I am nine years post radical prostatectomy and have always had results of < .01, but just a few days ago got a result of .04. If I understand the quoted Scandinavian passage above, that is still insignificant, by their standards, correct? Do American doctors follow that standard? And could there still be benign tissue five years post surgery (or nine)?

This is a good thread and something I currently have questions about. My bf had his surgery in October of 2013, Gleason 6. They are obviously doing the ultra sensitive test since his first score was .001. Last spring his score was .002 and last week .003. He is now being tested every 3 months. His doctor said they would watch it and not to worry till it got to .005 I wonder if he meant at .05? Based on what is being said in this thread, even that would seem like jumping the gun. Any input or thoughts on this matter would be helpful. We are trying not to freak out, but I can tell this has effected my BFs mental state a bit. He has had a great recovery and his ED has improved greatly. 50mg of Viagra does the trick. Since everything is back to normal, or about as close as normal could be, thinking about a recurrence is bringing us down. Thanks

I got confused about your ultrasensitive test results. Three digits precision far below the 0.1 and 0.2 levels make no sense to me if the standard is not questioned: "After RP, PSA should be undetectable (< 0.1 ng/mL). A PSA of > 0.1 ng/mL after RP is a signal of residual prostate tissue. After an undetectable PSA is obtained following RP,a PSA > 0.2 ng/mL, and rising, is associated with recurrent disease."
I was at peace with my <0.05 undetectable tests and will have my next test within a few weeks.

Gemlin,

What may be confusing you is that your data is outdated. When PSA was first used in the 1990s, .1 was the lowest detectable amount, so .2 was arbitrarily chosen as the point where we could definitely know there was progression. So the definition of biochemical recurrence was based on that. Since then, ultrasensitive PSA, and the understanding from 3 randomized clinical trials that early salvage has better outcomes than waiting have changed practice. The optimal cutpoint has yet to be determined based on clinical trials, but database analysis has shown that when there is adverse pathology, .03 may be a better cut point. Still, overtreatment is a concern, and we look to other indicators than just absolute PSA to determine risk of progression (e.g., PSA nadir, PSADT, PSM, stage, path Gleason score, CAPRA-S, other nomograms, Decipher).

- Allen

Post Edited (Tall Allen) : 8/16/2015 12:14:25 PM (GMT-6)

Thanks NKinney--- In the post above--I posted what I think are he important points about my post rp patho----- what are your thoughts? Thanks for your valuable input amigo---

Thanks much Norm--- I'm chillin like a villan!!!

Exactly why ultra sensitive PSA tests cause more harm than good. Enjoy your good tidings and rejoice

BillyBob@388 said...

Babs83 said...
This is a good thread and something I currently have questions about. My bf had his surgery in October of 2013, Gleason 6. They are obviously doing the ultra sensitive test since his first score was .001. Last spring his score was .002 and last week .003. He is now being tested every 3 months. His doctor said they would watch it and not to worry till it got to .005 I wonder if he meant at .05? Based on what is being said in this thread, even that would seem like jumping the gun. Any input or thoughts on this matter would be helpful. We are trying not to freak out, but I can tell this has effected my BFs mental state a bit. He has had a great recovery and his ED has improved greatly. 50mg of Viagra does the trick. Since everything is back to normal, or about as close as normal could be, thinking about a recurrence is bringing us down. Thanks

Well 1st of all, his post op pathology was G6, right? And if so, most likely it was all contained, right? No +margins, SV invasion or lymph node invasion? If all of that is the case, I would not be too concerned. After all, the chances of death from PC from a G6 - regardless of all else- is exceedingly small. This is of course assuming all is correct in the reading of his post op pathology.

So what are these .001 tests called, ultra-ultra-sensitive? Undetectable is < .1 with the regular test like Smith at Vanderbilt ran on me. < .01(like my local URO's lab gives me) is called the ultra-sensitive test I suppose . Now there is even a requirement to be <.001 to be called undetectable if you use that lab?

So I could be an actual .009, being told I am undetectable because I am <.01, even though I am 9 times higher than your BFs 1st reading of .001, but he is considered detectable? Because they detected .001?

I know of studies that indicate getting to .03 means a probable future BCR(bio-chemical recurrence, which is by no means the same as metastasis and/or certain death), i.e. will very likely get above .1 or .2 in the future. I am not aware of anyone anywhere(could be wrong) who worries about anything/considers any treatment, until we get above(or is it to?) .03. That is still 10 times what your BF has risen to. Plus, he is still a G6. So probably not yet time to panic seems to me, always time to panic later above .03. Not that you were panicking, but if you wanted to it would be better to wait until it doubles a few more times.

BillyBob,
Thanks for your reply. Yes BF's biopsy and post op Gleason were both 6. These were only read by the lab which his surgeon used. We never sent any out for a second opinion, so that is what we know. I have not read his pathology report so I don't know about +margins, SV invasion or lymph node invasion. His doctor told him after the surgery that everything was great. I wanted to read the report, but because he was told everything was great, I didn't ask about it again. about a year ago, he saw his doc for his checkup and the doc was about to say, I'll see you in a year, but he changed his mind and said see you in 6 months, something about a positive margin. My bf asked his doctor what he meant because it was the first he had heard this. His doctor kind of brushed it off and my bf actually thought the doc was looking at the wrong chart. Never the less, his doc wanted him back in 6 months. It was that check where his PSA went to .002 and the doc said it could be nothing, see you in 3 months. We just got that PSA which was .003.

Now, of course, I really want to read the pathology report, but haven't asked to see it yet. I understand what you are saying about this Ultra-ultra psa testing. This three digit number is a reading some labs give. It does seem that this ultra sensitive testing .001 to the thousandths can create some undo stress. I understand I should not be worried at this point and I am not in a panic, but it is a back of the mind worry. This time the doctor said that it could be some benign tissue causing this, but he will recheck in 3 months.

Since it seems to make a difference that the final pathology report said it was Gleason 6, would anyone suggest we have that re-checked to make sure it was a G6? Is there anyway to have that double checked almost 2 years post surgery? Do they keep slides that long? Maybe that is just a waste of time.

Thanks Pocketman for sharing your PSA results and putting that in perspective.

Gemlin, Actually - I said nothing of the kind. I didn't reference European vs American standards at all. I only pointed out that the .2 cutoff for recurrence was set up in the 1990s when that was about as accurate as we can get. Since then we have learned a lot.