Not what I was hoping for

Not the ideal outcome, but still very low and you know it can bounce around and vary between labs.

Can't answer your first question, but I suspect MSKCC use 0.01 - I don't know this for a fact but in their nomogram, where they ask for pre-surgery PSA, it asks for inputs in the range: (0.01 to 100)

Stay strong.

Thanks guys.

So much for my low risk Decipher score. That's not giving me a warm and fuzzy feeling any more.

Re the hip, I'm inclined to think that with a .033 PSA, it's highly unlikely to be Mets. From all I've read here, .033 isn't even something that would show up on a scan.

I'm gonna just try to stretch it out and put heat on it, before I go running to a Dr, which would surely lead tome going down the black hole of medical tests.

Every cancer survivor fears recurrence. It just becomes part of our mental landscape. It's hard not to worry about it, and even more so when your numbers seem to indicate, well, something; or not. Thing is, you don't know what, if anything really is going on. That's why they developed the recurrence criteria, and for post surgery it's not "official" unless over 0.2. That's because of the variability of numbers bouncing around below that level that can appear concerning, but ultimately don't go anywhere.

All you can do is wait out the next PSA test. Watch the trend. If it ever does actually indicate a problem, you'll deal with it then. As I've posted here, I'm watching the same sort of thing with my numbers. It's maddening, but there's just not much else you can do. As someone here pointed out, it's a marathon run at a snail's pace.

So let's not lose the beauty of today worrying about tomorrow. Between tests, live your wonderful life. The more you focus on other things, your new Florida home or whatever, the less you'll hear that monster snoring in the closet! (Maybe you need to let Worried Guy take over for a couple more days a week?).

Redwing57 said...
Every cancer survivor fears recurrence. ........So let's not lose the beauty of today worrying about tomorrow. Between tests, live your wonderful life. ....

Exactly! I will admit when I have some new joint pain part of my brain wants to associate it with PCa but I try to quickly dismiss that pondering.

Not the number you wanted. In your place I'd be temped to have a conversation with an RO about SRT. I won't comment on its effectiveness, but you might want a medical opinion.

The PSA is too low to be causing hip pain. That's more likely do to the "A" word - age.

I think you're still in that frustrating watch and wait mode.

Hang in there,
Andrew

I forgot...you asked a question about nomograms...

Everything below 0.05 ng/mL (like all your results) is "undetectable" for the SRT nomograms. The lowest detectable limits may vary from method-to-method, but what test you use is totally inconsequential to the nomograms or the basis of the many thousands and thousands of cases from which the predictions are drawn.

Come back when you are no longer undetectable.

Thanks Jack, Jazzman.

I'm pretty confident too, Jazzman, that the hip pain is nothing. Still it's on my mind, as you never know. I've been avoiding going to an orthopedist because I know once I do, I'll be in the black hole,of unnecessary medical tests. But it's been bothering me for a while, so I guess it's time to do that.

As far as the PSA, it's funny (not really funny( the 3 digits bothers me. Hearing that it went from .02 to .03 in 5 months, sounds better to me than hearing it went from .02 to .033. How ridiculous.

I think that this may still be good news as there are big differences between assays. One post op assay had my husband's psa at 0.01 another at 0.03. Both were not undetectable and we decided to go with the first lab ongoing. His psa ticked upto 0.02 at year 3, went back to 0.01 once or twice and has now settled at 0.02. Our guess is that it's actually around 0.015 and is caused by the surgeon leaving some tissue behind while he was cutting around the nerves.

Since you have changed assays the new test might be equivalent to a lower number. Yes you are detectable but it might stay stable for a long time.

An

I agree with others that the hip pain is nothing to worry about. Going into a doctor appointment not long ago the nurse asked the usual question about if I'm experiencing any pain and I said no. She said none? I said, well no more than goes with being 70 years old and she just laughed.

As for the PSA, you need to see the next test result to be sure it's an increase, especially with the different lab. But I think you are on an upward trend. After my surgery I had 4 or 5 years in the detectable but below .04 range and then jumped to .1 for a couple more years. So, with a bit of luck you may hover at a low, but detectable, level like I did. But if the upward trend continues, don't do as I did and wait until 0.4 for SRT. At the time -- seven years ago -- .2 was still considered the trigger point for SRT and I jumped to .4 withing months of my first .2. I wonder if earlier SRT might have prevented the recurrence I'm having now.
Jim

Thanks Andrew, Peter, Rob, Jim and An.

@Andrew, yeah, i thought about that, i'll be back to you and others here, if it turns out to be a need, for some names.

@Peter, LOL @ "IF YOUR JUNK GLOWS IN THE DARK"

@Jim, and An, thanks your stories of your experiences are encouraging.

@Roblee, yeah, i am thinking even though it sounds worse with the 3rd digit, effectively I've gone from .02 to 03.

And just to be clear, I'm not panicking , worried, yes, panicking, no. For some odd reason (probably i know more), i am way less crazed than when i first got diagnosed.

I am sorry to hear that it was confirmed, but wherever it is, it is slow and way too small to be detectable.

I agree with PDAs comments. First, let me remind you of what the Koulikov study found - that if the PSA velocity was less than 0.05 ng/ml/year (and yours is much less than that, assuming the lab switch had no effect), 94% were still recurrence-free (PSA<0.2) 7 years later.

/pcnrv.blogspot.com/2016/08/low-detectable-psa-after-prostatectomy.html

The MSK nomogram you are trying to use is just not valid for you. That nomogram was based on patients treated between 1987 and 2005. All patients had a confirmed PSA ≥0.2 ng/ml before SRT. It depends on PSADT, which is not valid for uPSA; and you have to know the number of months before your PSA reached 0.2, which has not occurred for you.

There is a newer nomogram by Tendulkur that PDA was referring to. It shows the probability that radiation treatment will be successful at lower PSAs. However, I would caution that even with their sample size of 2,460 patients treated between 1987 and 2013, the vast majority were treated after their PSA≥0.2, and with radiation doses that many would now consider to be too low. The sample size for men in your particular situation would be very small, and the reliability of it for you is low.

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html

Talking to an RO would not hurt, and Zelefsky at MSK would be my first choice if I were in NYC. He may suggest a Decipher test, or MSK may be testing some new genetic analyses.

The median time from BCR (≥0.2) to a detectable metastasis (let alone one that can cause pain) is 9 years, so your hip pain is due to other causes.

Sorry to hear about the numbers. They are still low but increasing. I had undetectable PSA after surgery for 6 years. After being undetectable, my results went to .02 to .032 over the course of a year. I then pulled the trigger and had SRT. I may have pulled it too soon but decided that was the best decision for me. Also, I was a Gleason 8. Sometime patience is a good virtue to have in dealing with medical issues.