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URGENT ADVISE NEEDED -REGARDING PSA RESULTS

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Posted 1/28/2017 9:34 PM (GMT 0)
Hi I've received my 2nd psa results today from the same laboratory however I've just noticed the difference in the serum used.


Nov-16 psa value <.008 shows serum used as CLIA.
JAN-2017 PSA VALUE = .033 shows .033


Not sure difference is due to the different serum used????


any advise???



thanks
Posted 1/28/2017 10:44 PM (GMT 0)
My advice is to ask the doctor. If the reading of .033 is accurate, that might be a sign of recurrence. Ideally, your samples are being tested at the same lab, using the same procedures so that there results are comparable over time. But ask your doctor as soon as possible to allay unnecessary concern. Good luck! I'm in a similar situation, with my first post-surgery coming in at <.008, and the second at .01. I'm waiting for the next test to see if the .01 was an aberration or the start of a trend.

I believe that in many cases the PSA will rise and then drop back down again.
Posted 1/29/2017 12:57 PM (GMT 0)
Hi Jack -

Good to have a reliable, convenient lab and use it consistently. We all have PSA-anxiety. I go with quarterly testing - would back off to semi-annual, then annual were I undetectable for a spell. We know there are better outcomes with relatively early secondary therapy - better before 0.2. When I got a .03 I did another test at something like 5 weeks later which was .06. Went hard at diet and it's receded back to .03 for most of a year. Another test Monday - so it's on my mind today also.

Best to you -
Wilderness
Posted 1/29/2017 1:06 PM (GMT 0)
Hi. For what it is worth, Henry Ford Hospital only measures PSA to one decimal point (i.e 0.1). They told me that taking it out to two or more is not reliable, and that as long as I am <0.1 I am OK. Personally I think it is more a matter of cost.
Posted 1/29/2017 1:36 PM (GMT 0)

Dr WHO said...
Hi. For what it is worth, Henry Ford Hospital only measures PSA to one decimal point (i.e 0.1). They told me that taking it out to two or more is not reliable, and that as long as I am <0.1 I am OK. Personally I think it is more a matter of cost.


Same for MD Anderson and my VA lab, their PSA test only goes down to 0.1, like you i'm a happy camper as long as I'm <0.1
Posted 1/29/2017 2:33 PM (GMT 0)
So we've got these great, well respected institutions like MDA, and Ford, testing to .1. It makes no sense that other institutions don't follow their lead. I wonder why that is? Can it be that an institution like MDA is behind the times?
Posted 1/29/2017 3:10 PM (GMT 0)

jack1954 said...


Not sure difference is due to the different serum used????


any advise???



thanks


Advice?


Certainly it is different serum if it was drawn from you blood on different dates.

Serum is a clear liquid carried by your blood throughout your circulatory system, sorta like plasma. Prostate specific antigen can "bind" to the serum (but not to the blood). So when you have a PSA test, the first thing that's done is to separate the blood from the serum, then measure the concentration of the "bound" PSA in the serum. Some unbound PSA may be "free" (or "unbound") in the blood, but the measurement you get back is of the bound PSA in the serum sample...unless you also requested a "free PSA" test, too, when you get the percent free-to-bound.

Every new blood draw generated new, different serum sample.
Posted 1/29/2017 4:08 PM (GMT 0)
The .033 result could be a false positive or the beginning of a trend upwards. Only further tests will show what. The test you are using is so sensitive that it detects clinical insignificant cells in the body making PSA, these aren’t necessarily cancer cells (if PSA is not rising over time).
Having detectable PSA after surgery can be stressful so in my opinion the labs shouldn't report anything below .05 to spare us from unnecessary anxiety.
Posted 1/29/2017 5:49 PM (GMT 0)
Its not serum sorry its assey used clia/cmia.
Posted 1/29/2017 6:17 PM (GMT 0)
Are you referring to the rapid test system machine versus a lab based test?
Clearly laboratory-based methods have a better analytical performance, and is preferred if you don't need a quick result. I always use lab-based, have to wait a day or two though.
Posted 1/29/2017 6:44 PM (GMT 0)
No its from the lab, in fact same lab but report this time says different assay name
Posted 1/29/2017 9:49 PM (GMT 0)

jack1954 said...
No its from the lab, in fact same lab but report this time says different assay name

I have seen this before. The first two tests my surgeons hospital lab ran came back reporting 0.00. The assay used was listed. The next two tests came back at <.02., <02 and most recently, .02. Those three also showed the assay used, and it was different from the first two that reported 0.00.

Not sure why the same lab uses different assays. Seems like that shouldn't happen.

Post Edited (Pratoman) : 1/29/2017 3:50:07 PM (GMT-7)

Posted 1/29/2017 10:10 PM (GMT 0)
A big lab is like a factory. Have you ever been in a factory? A factory may have multiple "assembly lines" which have similar equipment, but maybe not identical. Maybe the newest assembly line has the newest models of assembly equipment. The company needed to expand capacity, so they bought the latest of each model equipment for the new line, but they didn't scrap the old line...they keep cranking out product from it.

The labs--all of them--are similar. They probably have similar equipment of different generations side-by-side; probably even some equipment from different manufacturers next to that. They all run tests. The jobs get "batched" up in trays, and the trays are automatically fed into one of the analyzers...it's all highly automated.

Back in June (or whenever), someone's blood sample might have been batch processed through analyzer "D," but this time it get processed through the an older piece of equipment, analyzer "B." Both have capabilities to conduct ultra-sensitive PSA tests...although maybe not to the same lower detection limits.

The company has multiple motivations to standardize on identical equipment...just as a factory does. It keeps maintenance simpler and the total cost of ownership lower. But, they are not going to scrap old equipment until it's fully depreciated...they'll keep using it side-by-side with the new equipment until then.

You have no idea which piece of equipment it was run on, nor should you. Identical equipment as the same assays; different equipment may or may not have the same assays. Sounds like in this case, it was different.


To me, the only thing of interest is that the new (Jan-17) measurement does not have a "<" sign...is that right?
Posted 1/29/2017 10:13 PM (GMT 0)
Yes however no = sign either
Posted 1/29/2017 10:16 PM (GMT 0)
Well, one would look for multiple consecutive increases before it is actually tagged recurrence.

What was your post surgical pathology?
Posted 1/29/2017 10:18 PM (GMT 0)
Aarrgh its gleason 10 pt3bn1
Posted 1/29/2017 10:33 PM (GMT 0)
Well. I suppose that you knew that a recurrence in PSA was likely; indeed probable. It's NOT that at this point—as I said, not until there are 2 consecutive increases. But unfortunately you've had one.

The ultrasensitive PSA test was very appropriate for your case.

With 5+5, N1, it's probably not too early to start looking into caregivers (oncologists) for next steps.

What was your biopsy histology that led you to choose surgery as first-line therapy?
Posted 1/29/2017 10:35 PM (GMT 0)
Biopsy 5+4 mri ct all clean. Psa value before surgery 12. Thats the reason I opted surgery. 21 lymph nodes removed and 1 positive.
Posted 1/29/2017 10:37 PM (GMT 0)
5+4 at biopsy. Surgery was a long shot...but I understand taking it.

Still lots of tools in the toolbox to deal with it.
Posted 1/29/2017 10:39 PM (GMT 0)
well I wanted as much as CA I out of ny system
Posted 1/30/2017 3:02 AM (GMT 0)
My Joe had da Vinci radical prostatectomy at Henry Ford hospital in November 2009. Gleason 7 (4+3), PC in one of 16 surrounding lymph nodes. PSA <1 post surgery. Up a bit soon after. Radiation of the pelvic floor resulting in scarring = minor incontinence since then (ditropan)
Wanted to start HDT in 2011.
Instead went to Cancer Treatment Centers of America (CTCA). VERY happy w/ watchful waiting and multi-faceted care team.

November 2016 blood test showed nearly tripled PSA. CT scan showed three masses: one in trachea, two in right lung. None lit up with pet scan, but biopsy of tracheal growth positive for PC. Started Taxotere and Lupron last Monday......

Incredible bone pain in lower legs and feet since Wednesday....two nodules today in his belly....lymph nodes reacting to the assault on his body or worse?

I don't know what to expect, time-wise, but we'll fight the fight as best we can ......Thank goodness for CTCA!

God bless us all!
Posted 1/31/2017 2:54 AM (GMT 0)
You are still well undectable. No verified evidence of recurrence. Good reason to stay away from ultra sensitive testing, all it leads to is needless anxiety, seen it a hundred times here at HW. If there is recurrence, stick to the same lab, same method, and after another couple of rounds of testing, you should be able to see if you are truly going up or not. .033 is still a great number, many would be so happy for it.
Posted 1/31/2017 3:40 PM (GMT 0)
Jack,

Seven years ago I was part of a study that compared post surgical PSA readings reported by 2 different methods.
I can't find the later posting with more of my data but it is on this site somewhere.
Go to this question and scroll down to my comments.
https://www.healingwell.com/community/default.aspx?f=35&m=1928424
Here are some numbers.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04
1/14 6 months - 0.05 (Siemens Centaur)
4/14 9 months - 0.04 (Siemens Centaur) and <0.01 (Roche ECLIA).
7/12 1 year - 0.03 (Siemens Centaur, direct chemilum); <0.01 (Roche Cobas 601 ECLIA)

Supposedly, the "newer" (now 7+ years old), Roche Cobas 601 ECLIA gave more pertinent results. But even that is 7 years old. Machines continue to get better and more accurate.
about 2 years ago the University of Rochester decided their low threshold should be <0.02 and do not report numbers below that. Note I said 0.02, not 0.2! They consider a reading of 0.02 a valid reading. A 0.01 is reported as <0.02. So is 0.018.
Posted 1/31/2017 4:20 PM (GMT 0)

Purgatory said...
You are still well undectable. No verified evidence of recurrence. Good reason to stay away from ultra sensitive testing, all it leads to is needless anxiety, seen it a hundred times here at HW. If there is recurrence, stick to the same lab, same method, and after another couple of rounds of testing, you should be able to see if you are truly going up or not. .033 is still a great number, many would be so happy for it.

I will respectfully disagree with just about every one of these comments, for very good reason: they are both wrong and misleading

    i) "You are still well undectable [sic]." — Your PSA is not undetectable. If it was undetectable, it would have included a "<" sign indicating that it was below the lowest detection limit of the test; but you reported it did not include that "less than" sign. It is low, but it is detectable. Also related to item iii), below.

    ii) "No verified evidence of recurrence." — This sentence is correct. BCR is only verified following surgery after 2 consecutive increases as I previously mentioned, which you have not had.

    iii) "Good reason to stay away from ultra sensitive testing, all it leads to is needless anxiety..." — No, with your high-risk diagnosis and post-surgical pathology, you are exactly the patient that should be using the ultrasensitive PSA test. Patients with favorable-risk cases going into surgery and favorable pathology post-surgery should not be prescribed the ultrasensitive PSA because it causes undue "PSA anxiety," but this is not your case.

    iv) "If there is recurrence, stick to the same lab, same method..." — This advice is backwards. Frankly, once BCR is verified, the precision of the PSA test becomes much less important. However, at the lower levels of PSA and before BCR, this is the time when patients should do all they can within their control to follow consistent testing procedures.

    v) ".033 is still a great number, many would be so happy for it." — I agree that it is a low number, and for now is "good," maybe "great." The only concern is, as I've said, that it does not include a "less than" sign whereas your prior reading was less than a lower value.

Post Edited (JackH) : 1/31/2017 9:28:03 AM (GMT-7)

Posted 1/31/2017 4:45 PM (GMT 0)
There is a bit of right in a lot of wrong...a bit of wrong in a lot of right...hence the dilemma of existence...do what you are going to do...if it is wrong..."do it quickly"...If it is right...timing wont matter...which brings the post full circle...just trying to navigate...with my co-pilot...tis a puzzlement...et cetera...et cetera...et cetera...
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