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Posted 3/15/2016 4:35 PM (GMT 0)
I have some questions.
My fiancé is about 15 months past RP. His last psa test (not ultrasensitive) was 0.1. He retested 1 week later, yesterday, and it came back <0.1.
great news of course! but ... now I am wondering is it just bouncing around 0.1 now? if we are not doing the ultrasensitive testing would we not know that? could he be 0.09?

Does anyone know what the +/- is for the not ultrasensitive test? could <0.1 be 0.095?

When I mentioned we should consider doing the ultrasensitive testing he was not a happy camper. Maybe it was too soon after receive good news. I am not always the most patient. I thought I was good waiting until he got his results :)

all the reading I have done now makes me more worried. After the RP like we were all good, done, and nothing to worry about going forward. Now with my (obsessive :) ) reading this past week it appears with his stage T2c & gleason 7 (3+4) he is at a 50% chance of BCR within 5 years and not sure how much the positive focal apical margins make that even more likely.

I am pretty sure he has no idea of this and not sure how to broach the subject with him. I don't want to be a downer and worry him more.

Thanks!
Posted 3/15/2016 4:47 PM (GMT 0)
I don't think it's possible to know (or read into) what the underlying PSA number might be if it's reported as < .1 Halbert and others with a more scientific background may be able to offer additional insight.

I'm in a similar boat. My first two PSA's were reported as < .05, then the following two reported as .03

So was I .01 then .02 on the first two, meaning I now have a rising PSA? Or was it .03 all along so I'm detectable but low and stable ? No way to know, the only thing you can do is repeat the PSA test and look for a trend.

I think the more sensitive test might be a good idea in your case. Not knowing is often times worse than reality. For me I wish they had reported all my PSA's as < .05. Knowing I'm .03 doesn't change any treatment options at this point but it sure does give me heartburn.

Jon
Posted 3/15/2016 5:17 PM (GMT 0)
The less than sign means that the testing equipment can't go any lower.

So a <0.1 could actually be 0.01 or 0.09

The ultra-sensitive test in my opinion should be eliminated as recurrence level is 0.2 or higher. So what purpose does those ultra-sensitive test do?? In my opinion it just causes consternation.
Posted 3/15/2016 5:32 PM (GMT 0)
It's more likely a lab/reporting error.

take the <.1 and run with it.

Andrew
Posted 3/15/2016 5:57 PM (GMT 0)
Because we know that treating before the PSA reaches detectable levels on the conventional PSA test has better outcomes, I think you are right to switch to an ultrasensitive PSA (uPSA) test. I wouldn't be too concerned about the one anomalous finding, especially with his overall good pathology. The positive focal margin in itself is not a cause to jump into salvage radiation, but if he develops steadily rising uPSA it may be.

- Allen
Posted 3/15/2016 6:46 PM (GMT 0)
Thank you all.

I think any measurement can be a source of anxiety, especially for those of us (including me :) ) who are prone to it.
If not ultrasensitive - then what is it doing that I might not know?
If ultrasensitive - is this small move meaningless or does it mean something?

It probably depends on ones personality, what feels more comfortable.
I want as much information as possible. I don't want anyone else to decide for me what I should know or not know. I think my fiancé might be on the other side of that.

I have heard of a few who have started IMRT at 0.03 or lower. I have also heard that any PSA of 0.03, after RP where it went to 0, should be considered a BCR. without ultrasensitive we wouldn't know this.

Tall Allen,
Do you have the information on treatment prior to detectable levels? I have seen studies that treatment at lower psas is better - from 0.2 and up but I haven't seen any for lower.

Thanks much! Freda
Posted 3/15/2016 7:28 PM (GMT 0)
The last review I wrote is below. It has links to all the other uPSA studies.

Johns Hopkins: ultrasensitive PSA after surgery predicts biochemical relapse

- Allen
Posted 3/15/2016 8:33 PM (GMT 0)
A recent study found that men with stage pt3 disease or positive margins should have adjuvant (ART)or salvage (SRT)radiation. Whether or not one is better than the other is still controversial. Typically biochemical recurrence (BCR) is defined as two successive readings of .2 which is the protocol I followed. If this definition is used then ultrasensitive PSA is unnecessary but if you want to take action more quickly then ultrasensitive could be helpful but could cause unnecessary anxiety because PSA can fluctuate in that small three decimal range (i.e. .xxx) which seems to be the case with Ted's readings. Your urologist knows all this and should guide your decision on any next steps required.
Bob
Posted 3/16/2016 4:35 AM (GMT 0)
Thank you Allen & Break60.
Posted 3/16/2016 12:42 PM (GMT 0)
I would take the I would take the < 0.1 like "InTheShop" mentioned and run with it.... You kight consider doing another test in a few months though. I had received <0.1 using the standard test for 7 years. Then in November 2015 it came back as 0.1 I was concerned. Thus, I went to the untrasensitive test last month (FEB 2016) and received a report of < 0.02 Go figure that out...

All my tests were from the same lab....Quest
Posted 3/17/2016 3:47 AM (GMT 0)
That was good news Woodstock!

I guess we will ride the <0.1 wave. Maybe later he will consider ultra sensitive testing and maybe not. He isn't hot on the idea.
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