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1st PSA test following RALP - anxiety related questions, please bear with me :-)

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Posted 8/2/2017 4:10 AM (GMT 0)
hey all-

my husband is going in for his 1st PSA test tomorrow following surgery in june (via Quest) -- what's the turn around time on these tests? a full week? a few days? what has your experience been like?

also, i'm still having a hard time figuring out what undetectable means in re: follow up PSA tests. do we have to have a "<" in front of the number in order for it to be undetectable? our doctor said he wouldn't be happy with anything higher than 0.05 -- did he mean to say <0.05?

and isn't the favorable number actually <0.02?

not sure why i can't figure this out, i keep getting confused over and over.

thanks in advance.
Posted 8/2/2017 4:51 AM (GMT 0)

pwallace said...
hey all-

my husband is going in for his 1st PSA test tomorrow following surgery in june (via Quest) -- what's the turn around time on these tests? a full week? a few days? what has your experience been like?

also, i'm still having a hard time figuring out what undetectable means in re: follow up PSA tests. do we have to have a "<" in front of the number in order for it to be undetectable? our doctor said he wouldn't be happy with anything higher than 0.05 -- did he mean to say <0.05?

and isn't the favorable number actually <0.02?

not sure why i can't figure this out, i keep getting confused over and over.

thanks in advance.

never been great at math, more of a concept guy myself....so others will be along....here's my deal....

< is a sign that means "less than"

your doctor meant anything less than .06 (<.06) he's happy with. so.... .05 or below is my take on his take as to what he would be happy with or not

the "favorable number" (your words) of <.02 doesn't apply to your husband. You've gotten the numeral .2 in your head because you've seen it here before. It''s the clinical definition of a recurrence of cancer after tx. <.02 is not a clinically significant number in or of itself. it's just an arbitrary number you've confused with .2


the seemingly unspoken, yet universally accepted time after a prostatectomy for a hard, correct PSA number is usually taken at the 3 mo. mark after surgery. Since your husband is getting checked before 3 mos. it would not be unusual for there to be some PSA. (Hopefully .05 or below...or, in other words <.06) My PSA was taken at 10 weeks and I had a PSA of .01 (2 weeks before the usual 3 mo. check). At my next check...it had fallen to .00

So, I believe the fine physician will just be checking his PSA....expecting some PSA to be there *probably*.....and then he will most likely check it again in a few weeks. The reason for the check now is to see what kind of trend may be happening from tomorrow to his next PSA check in a few weeks.

your doc can speak for himself more than I can. but....this is my take
Posted 8/2/2017 5:01 AM (GMT 0)
Howdy pwallace

the "<" sign means "less than". (or a lower number than)
the ">" sign means "greater than" (or a higher number than)
They are standard symbols in math for numbers on a number line or scale where smaller numbers are toward the left and bigger numbers are toward the right.

As for PSA test turnaround times, I use Quest Diagnostics in Northern California. Both my local oncologist or a specialist I see at UCSF can submit standing electronic orders to the Quest facility of my choosing. I've found it convenient to go on-line and establish a MyQuest Patient Portal account that I can log into. I can make convenient Appointments for my Labs well in advance. Saves time, and lets me schedule at my convenience.

The specialist I see at UCSF gets the results electronically, and I can often see the results on-line on the comparable UCSF MyChart system within less than 36 hours. The UCSF MyChart system also makes nice tables and charts of past lab results.

My local oncologist's office does not have a comparable system, but typically gets the results faxed to them within approx. 2-3 days, and I can ask for a copy of the results for my records the next time I have an appointment, or if I drop by the office somewhate earlier. (If I have no appointment with the local oncologist, or do not go by the office, the MyQuest Patient Portal eventually releases the results for my on-line viewing after giving the ordering physician time to have discussed the results with first.)
The MyQuest Patient Portal also makes tables and charts of past lab test results.

Charles
Posted 8/2/2017 6:53 AM (GMT 0)
Each lab has its own lowest number that it can detect for a given test. Anything less than that (<) is "undetectable." So you are right that you have to see a "<" for PSA to be undetectable on that test at that lab.Undetectable on a conventional PSA test, where they only have one significant decimal, is anything <0.1 .

Undetectable doesn't necessarily mean it's favorable. Whether it's favorable is a judgment call. For someone with your husband's pathology, any PSA≥0.03 predicts full biochemical recurrence almost certainly (98%) according to the Kang et al. analysis.
Posted 8/2/2017 10:54 AM (GMT 0)
The value of the "<" depends on the test being used. As equipment and methods are improved, that detection limit gets lower, and adds to the confusion. For a long time, the most common test method was pegged at 0.02, so anything below that was reported as <0.02. Now, there is a method that yields a minimum value of 0.006, so you could see a <0.006. I'm sure, in the near future, someone will refine the method and the machine to yield a <0.001. I'm a skeptic. At some point, the medical community will need to agree on a uniform statement of "we don't care how far below X it is, anything below X is good, and the number of leading zeros is meaningless."

You didn't say when in June he had surgery. This has come up several times recently, where we note that many surgeons do a PSA at about 6 weeks post surgery, which can create some false anxiety, because it can be too early depending on what the initial PSA was before surgery for it to reach zero because PSA has a half-life (it drops 1/2 every so many days, and it can take over 6 weeks to half itself into non-existence).
Posted 8/2/2017 4:14 PM (GMT 0)
P,
My husband gets his PSA tests at Quest in Anaheim Hills. We get a call from Ana in Dr. Ahlering's office in 2 days. I signed up for the Quest Portal but it takes almost a week before the results show up there. Good luck, I hope you get the low results you want. Keep us posted.
Posted 8/2/2017 11:42 PM (GMT 0)
thank you for all of your responses! greatly appreciate it.

i've always understood the greater & less than signs, but i didn't realize they had to be printed on the actual lab form in order to be undetectable. and i've seen blog posts here & there where people talk about losing their "<" so i was a bit confused. thanks for the clarification!

tall allen- that <0.03 number was the one i was looking for in re: to biochemical reccurance, but for some reason i thought it was <0.02.

some sites say it needs to be even lower - 0.003 for example as per johns hopkins: http://urology.jhu.edu/newsletter/2012/prostate_cancer_2012_14.php

does quest use accuPSA test? how can we find out which test we're getting?

up4thefight- thanks for the info re: turn around time. just searched the archives to see your last post b/c somehow i missed it. how are you guys doing? what's the next step? will you wait to see more of a trend or are you meeting with RO now? thinking of you guys big time. will let you know when we hear back from ana and/or lydia as well. ugh, so stressful.
Posted 8/3/2017 12:11 AM (GMT 0)

pwallace said...
tall allen- that <0.03 number was the one i was looking for in re: to biochemical reccurance, but for some reason i thought it was <0.02. some sites say it needs to be even lower - 0.003 for example as per johns hopkins: http://urology.jhu.edu/newsletter/2012/prostate_cancer_2012_14.php

You seem to have several concepts confused. Let me try to clarify:

"undetectable" means less than the specific PSA test at that lab can reliably detect. The JH article you referenced is only saying that what was undetectable in the 20th century is very much detectable in the 21st century. In fact there are now superultrasensitive PSA tests that can detect amounts of PSA as low as 0.003. But what you would use that test for is beyond me.

"Biochemical recurrence (BCR)" was arbitrarily set at 0.2 back in the day before uPSA was readily available. It has no real meaning beyond being an arbitrary benchmark. The related idea of "salvage radiation" is radiation that is given after BCR is reached. This has been mostly discarded.

"Unfavorable uPSA" is perhaps a better way of thinking about it. It is the uPSA at which one should think about "early salvage" radiation after prostatectomy.

For example, a uPSA of 0.01 is detectable, it is not a BCR, and most doctors would consider it as favorable, and not a reason to consider early salvage RT. A PSA of 0.03 with adverse pathology is detectable, is not a BCR (although it reliably predicts BCR), and many ROs would consider it as unfavorable and a valid reason to consider early salvage.
Posted 8/3/2017 1:07 AM (GMT 0)
thank you for taking the time to walk me through this, tall allen.

i like the idea of thinking about it in terms of unfavorable uPSA b/c that's why i've written this post in the first place. with my husband's adverse pathology (EPE, tertiary 5), we are hoping for the best, but preparing for the worst.

really appreciate your feedback.

p.s. halbert, his surgery was 8 weeks ago, not 6. i think that's a good time frame for testing, right? his last PSA b4 surgery was 6.4.
Posted 8/3/2017 2:48 AM (GMT 0)
Just had my first test too. Mine at 3 months. Got it back in one day. I think at 8 wks you may have residual psa. Could very well go down. I had epe like your husband but also negative margins.

Not sure what some of the other specifics of your pathology might mean as I'm no expert but I am glass half full on all this thinking negative margins are good and may trump some other not as ideal results. At this point I think no value in worrying about the tests this early.

If it rears its ugly head again it will likely be a bit further down the road and the good thing is he will have healed up from surgery and made progress on continence and ed. Salvage radiation for a 3+4=7 is likely to do the trick if needed.

BTW I got my test through primary care doc and didn't even ask for ultra sensitive- just came that way. Maybe most labs default to 3 decimal points now? I feel it is useful as it gives you an earlier indication of trend that can be acted upon.
Posted 8/3/2017 3:04 AM (GMT 0)
Yes - 8 weeks is fine. There is no residual PSA by then.
Posted 8/3/2017 6:35 PM (GMT 0)
Not trying to threadjack, but I have a question about the sensitivity of the PSA test.

I had my RALP on 4/3/2017, and my first PSA test 6 weeks later. It came back <0.1, and my doctor told me it was undetectable. I have a follow-up test planned in October, and was planning to ask for the higher sensitivity test. Then I read a post here suggesting that for some people, the high sensitivity test created unnecessary anxiety when they saw minor fluctuations in the second digit of the reading (e.g. 0.02 -->0.03).

With that in mind, and self-identifying as the type of person who would worry about those small fluctuations, what's the consensus? Should intermediate risk G7 (3+4) patients like myself ask for the more sensitive test if its available?

Thanks,

Kit

Post Edited (Kcheves) : 8/3/2017 4:08:55 PM (GMT-6)

Posted 8/4/2017 5:45 PM (GMT 0)
yes, i'm sure the ultra sensitive test causes more anxiety, but the way i understand it is that it also has the ability to detect minuscule rises (the onset of BCR), so therefore you'd be able to treat at the earliest time frame...(our last shot for a cure)!

someone please correct me if i'm wrong here! smile
Posted 8/4/2017 6:20 PM (GMT 0)
I had a Quest "post prostatectomy" PSA test recently. It defines undetectable as < 0.02 using a Beckman Coulter assay
www.questdiagnostics.com/testcenter/TestDetail.action?ntc=14808
Posted 8/4/2017 7:08 PM (GMT 0)
I think you are correct pwallace, earlier is better for salvage treatment post RALP.

I had the uPSA test done every three months post RALP and I'm glad I did even though it did cause me some heartburn. It allowed me to seek salvage treatment at an earlier stage hoping for the best possible chance for a cure.

If the uPSA shows a clear trend, as mine did, why wait on treatment. If it bounces around as it has for some you can choose to continue monitoring or not. I felt only testing down to .1 there would be a chance I wouldn't start treatment until I hit .2 or even higher by the time I got into see the RO and begin treatment.

I saw the RO when my uPSA hit .05, we agreed to test again in 3 months (.07) and one more 3 month test (.09) for a final confirmation. He has had a handful of patients level off at around .07 for years hence the second confirmation.

Everyone is different and everyone's disease is different. Only he can make the decision if the uPSA is worth the extra anxiety it may cause.


Good Luck with whatever you decide. - Jon
Posted 8/6/2017 9:33 PM (GMT 0)
Hi PWallace, did you get the results on Friday? I'm hopeful for you all that the result is low. My DH has an appt with an RO, Dr. Ash, tomorrow to see what he has to say. We were so impressed with him when we went for a consult before treatment. I'm anxious to see what he has to now. Based on the MRI DH had done he had agreed that surgery would be a good option. Dang it, why couldn't the MRI see the 2mm Gleason 8 tissue at the apex. Was it too small? Dr. Ahlering saw it during the robotic surgery.
Not sure what questions to ask. I will do some research tonight. My hubby isn't very motivated to tear into the mountain of studies and info. He wants to let the drs. handle it. He thinks that's what we are paying for. I need to come at it with a more eyes wide open model. I know some drs don't love the words " I read on the internet blah blah blah" However, I had several drs at the consultations ask me if I had a medical background which is direct result of the HW site and other research I did.
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