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Posted 2/20/2016 11:06 AM (GMT 0)
I posted a few months ago That I had received 7 1/2 years of standard PSA tests from Quest as <0.1. Very good results and happy with the standard test. In November 2015 my result came back as 0.1 Obviously a concern for me and many questions came up ? Good advice here was to chill and get another test done, which I did 3 months later. I decided to get the Ultra sensitive - Post prostatemy test (code 14808x) done at Quest to get a better knowledge of how fast it might be moving. Doctor comes in and says great news.... Your PSA is <0.02 Basicially as low as it can read... While I am pleased, I can help but think why that wide fluctuation ? I know many have good thoughts here and is why I wanted to put out this post.

Still not taking anything for granted and am now going back to 6 month check, but will stay with Ultra Sensitive test Has anyone had that much of a change ?

History Surgery 3/2008 Davinci Albany, New York

Positive Margin Gleason 6 before and after... 7 1/2 years PSA < 0.1

Psa 0.1 11/2015 Psa <0.02 2/2016 (sensitive test)
Posted 2/20/2016 2:17 PM (GMT 0)
I had a test at VA that was .1 .
Retests other places showed they left "less than" symbol off or .1 was their lowest value in their test range.
Posted 2/20/2016 2:31 PM (GMT 0)
Others in here have reported issues with Quest and PSA values. It all seems to depend on exactly WHICH lab (location) does the analysis.
Posted 2/20/2016 3:40 PM (GMT 0)
results vary depend on the assay (test) method, the lab used, etc. It's to use the same test method (normal, ultra-sensitive), the same lab, and get the blood drawn at about the same time of day.

It can be difficult to compare results from varying methods.

Andrew
Posted 2/20/2016 9:58 PM (GMT 0)
I'm one of the guys that had problems with Quest. Woodstock, I vote possible lab error. If I were you, if they still have the blood from the original .1 result, I would ask your doctor to request that Quest Retest the same blood, using the ultra sensitive assay.

If it comes back with a different result, you should make some noise at Quest, because they can't be allowed to keep doing this to us.

I have the name of a contact if you are interested, email me.

I don't beleive that it's very likely you would get a result of .1, then an a <.02, without a lab error or a mistake by someone who inadvertently left off the < from the .1 result.
Go from a <.02 to a .03, or .o4? Sure. But .1 to undetectable? Someone please correct me if I'm wrong, but I don't think that's a normal fluctuation over 3 months
Posted 2/20/2016 10:48 PM (GMT 0)
I see you read the post carefully............. The issue is is what is more accurate 0.1 or < 0.02 ?
Quite a difference and 3 months of concern.... Some have chimed in on previous post that lab errotr is rare and not something to rely on... I AGREE with that. Replying on a lab error is crazy...

I have sent quest a question via their site 3 months ago and did not receive an answer. Other post have said the same thing. I'm not calling them out, but would love to have a discussion and have both samples to review..... From 0.1 to < 0.1 I'll but it... But from 0.1 to < 0.02 makes me think that needs to be looked into....
Posted 2/21/2016 3:00 AM (GMT 0)
I believe a lot of the Quest labs have gone to 0.1 as the lowest they test. I have used Quest since after my surgery and it came back <0.1 for 1 1/2 years. Then on 2014 it came back at 0.1 for the next 4 tests. I went and had an ultra sensitive test at my hospital and it has been 0.06 for a year now.

Bill from Floridacool
Posted 2/21/2016 3:47 AM (GMT 0)

woodstock97 said...
I see you read the post carefully............. The issue is is what is more accurate 0.1 or < 0.02 ?
Quite a difference and 3 months of concern.... Some have chimed in on previous post that lab errotr is rare and not something to rely on... I AGREE with that. Replying on a lab error is crazy...

I have sent quest a question via their site 3 months ago and did not receive an answer. Other post have said the same thing. I'm not calling them out, but would love to have a discussion and have both samples to review..... From 0.1 to < 0.1 I'll but it... But from 0.1 to < 0.02 makes me think that needs to be looked into....

Your right, I missed that there were three tests and misunderstood your post.
Unless I'm still missing something, I still don't understand how you went from .1, to less than <.02. Not telling you to hang your hat on a lab error, just saying it happens, more frequently than you may realize.

Re your inquiry to Quest, my experience wa, that they didn't answer the inquiry I sent through their website. So I called and made some noise. They put me through to their "patient advocacy" group, which escalated it to a higher level, and ultimately I was able to have a reasonable conversation with a senior level manager.

I no longer use quest for PSA, but that's me.
Posted 2/21/2016 11:33 AM (GMT 0)
You were correct pratoman There were 2 test in last 3 months... 0.1 in November 2015 and <0.02 just this February 2016... Bigmac has mentioned that his lab or others may be dropping the less than symbol. Still others here still have reports of <0.1 and I would assume some have to be from Quest.

Still as I mentioned I feel comfortable with the < 0.02 latest test. Glad to hear Bigmac has went to sensitive tests and is getting readings of 0.06... I would have another test done in 3 months again, but after going 7 1/2 years of <.1 then one test at .1 and now < 0.02 I think going back to 6 months is prudent... Comments on that ??? Don't want to crazy over it... Thanks for your comments and responses..
Posted 2/21/2016 12:33 PM (GMT 0)
If you still live near Albany, you could have a test done at Albany Med. They use ultra-sensitive methodology. You could also ask there for a second opinion with Dr. Hugh Fischer, if he is not already your doctor. A friend of mine has been a patient at Albany Med for a decade plus, and tests every six months. Fischer is the most prominent prostate surgeon in the area, but he has in the past done consults on questions like yours. Best wishes!

NewspaperLover
Posted 2/21/2016 1:36 PM (GMT 0)
I know for Labcorp the specific test must be requested with a different test code. The ultra sensitive test is described as being specifically used post treatment not pre-treatment. There is no point in using the ultra sensitive test pre treatment. The doctor should specify what test is being requested. My PCP does all my blood work typically. I had to tell his physician assistant what test code to use otherwise she would have used the standard test as she did for my post op test. It's a nuance PCP mau not be familiar with. Labcorp also has the option to chart your prior results with each subsequent test.

I'm guessing most major labs do both the regular and ultra sensitive test. The test that is wanted needs to be requested with the correct code each time up front.
Posted 2/21/2016 2:41 PM (GMT 0)
It's entirely possible to have a 0.1 followed by a <0.02, if different tests are being run. The standard test goes down to 0.1 as it's lowest measured value. It might well be a lot lower, but it won't report anything lower. The devil is in the details.

Yeah, it would be nice to have everyone doing the same test all the time and the same reporting rules for the test. But it doesn't work that way.
Posted 2/21/2016 2:54 PM (GMT 0)
Woodstock, I agree with your approach, be happy with the <.02, I would think, in all likelihood, it's the valid result, after 7 1/2 years of Undetectables.
Regarding the .1, probably should have been reported as <.1, because like you, I don't understand the wide fluctuation. That's why I thought "lab error", either in measurement or in not reporting with the "<"
i agree that going back to 6 months is prudent.
Posted 2/21/2016 3:29 PM (GMT 0)
Woodstock,
Since I had positive margins, I was having PSA test every 3 months. We continued after the Quest tests changed to 0.1. When I went to <0.1, actually 0.06, my doctor changed me to testing every 6 months.

With your history, I agree, every 6 months should be no problem.

Bill from Florida cool
Posted 2/21/2016 4:22 PM (GMT 0)
I agree with joebucks on the labcorp issue.

When we got my first psa after surgery we requested ultra sensitive. Doc wrote the script ultra sensitive, during check in at labcorp while they were inputing my info in computer we asked twice because we knew they did standard psa also, 'ultra sensitive right not the standard?'...'yes,yes,yes'. We looked on the sheet that we had to give to the labcorp tech it said ultra sensitive. We asked the tech after she drew the blood, 'this gets put in as ultra sensitive, right?'...'yes,yes,yes...if that's what's on the paper, that is what it goes in as'...week or so later we get the results and it is the standard psa. We called and complained and of course wanted them to redo it ultra sensitive with the existing sample but they said it was too late, they already got rid of that sample.

They gave us the code for the ultra sensitive and told us to give the code the next time we get tested to be sure.....crazy. But I do hate Quest for my own reasons not PC related so next time it's labcorp with the code. There is soo much incompetence around these days you have to be on top of EVERYTHING. Exhausting.
Posted 2/21/2016 4:43 PM (GMT 0)

InTheShop said...
results vary depend on the assay (test) method, the lab used, etc. It's to use the same test method (normal, ultra-sensitive), the same lab, and get the blood drawn at about the same time of day.

It can be difficult to compare results from varying methods.

Andrew

Another question is how well does the same test method repeat the test results on the same blood draw. If you test 10 different samples from the same blood draw, how much variation in results is there? Variation in results is a very common issue in testing and test methods.
Posted 2/21/2016 5:01 PM (GMT 0)
That is very interesting Inspector, I just assumed it would be black and white with the psa out of the same sample as long as a mistake is not made and same method is used. If true I would imagine the variation would be minimal, but I am just assuming.
Posted 2/21/2016 6:52 PM (GMT 0)
James, no, there is no such thing as a 'true' value in analytical chemistry. In truth, every reading is a +/- reading. I'm not sure what the values are for USPSA, but they might look something like this:

Reported value: 0.05
Limit of Precision: +/- 0.002
95% confidence value: 0.045-0.055
Detection limit: 0.02

Which means that your reported value of 0.05 is actually somewhere between 0.048 and 0.052, and if they ran your test 100 times, 95 times it would be between 0.045 and 0.055 (1 standard deviation either side of the mean). The detection limit means that the test has a low limit of 0.02, and anything below that will be reported as <0.02. Zero will never be reported.

Good labs run quality control known and unknown samples all the time, and use that data to find weaknesses in their systems. It's how you find if there is, for example, a problem with a specific instrument or technician. They generally don't tell us all this stuff, because most of us want a specific number, not a range of possible values (all of which could be 'right').
Posted 2/21/2016 6:59 PM (GMT 0)
Thanks Halbert. Good information to have....
Posted 2/21/2016 8:11 PM (GMT 0)
Halbert, thanks for the nice, easy to follow explanation. I worked in quality control for lots of years doing dimensional inspection work on lots metal parts for lots of applications. By the time you take into account all the factors you can think of regarding the accuracy of a measurement, all you really know is that the exact measurement of what you have is something you will really never know. There even is a factor of uncertainty that can be calculated. I don't think I ever felt sure about my uncertainty calculations. smilewinkgrin
Posted 2/21/2016 8:44 PM (GMT 0)
Re: "lab error": there has definitely been a lab error by some one. Unless I am missing something, or unless they just left the < sign off of the .1 result, it simply can not be both .1 and <.02. It can be both <.1 and <.02 of course, which would be the case if they left off the < sign for the .1.

But even if they did that, there has been an error(in reporting) IMO, since .1 and <.1 are not at all the same thing. But which one is the error: .1, <.02 or did they just leave(on purpose or by accident) the < off of the .1?
Posted 2/21/2016 9:54 PM (GMT 0)
you're welcome James and Inspector. At some point we'll be able to measure things at the molecular level, and this argument will become one where we quote Heisenberg, and debate whether the cat is dead or alive.
Posted 2/22/2016 11:33 AM (GMT 0)
Yes, BillyBob that is the question... Which is correct ? Without conclusive investigation, we will never know. Hey, maybe they are all wrong/suspect ?

Never really heard anyone question a good result...LOL The omission of the < (less than symbol) has been discussed. Doctor seemed to be pleased and suggested going back to 6 month check with sensitive test again.
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