Prostate Cancer Recurrence after 4 years...

Hi Joe -

That detectable bit gets your attention, but I think too low to act on. Retest makes sense to me, maybe after 8 weeks or so. If it is rising, getting a feel for how rapidly would be helpful in deciding how soon to move on it.

A number of us are using diet & exercise to slow progress with apparent success. Might help delay secondary treatment (if it ever comes to that).

And just maybe it will never amount to anything - here's hoping for that outcome.

Wilderness.

Joe-

You are still below the uPSA level that anyone would really worry about. The 3+3 at the focal positive margin may be growing or it may just be a random fluctuation. Maybe think of it this way - if you had originally been diagnosed with that tiny bit of GS 3+3, everyone would be recommending active surveillance. It may never progress (GS 6 often doesn't). I think a uPSA in 3 months may convince you of its indolence or it may disappear.If it increases convincingly,a visit with D'Amico is a great idea.

Hi Wilderness,

Thank you for your input. I had a focal margin at the bladder neck with G 3 + 3 = 6. I will retest for sure. I keep trying to eat healthy and trying to exercise (biking, tennis, basketball) reasonably often. Which lab do you use for uPSA?

Joe.

Hi Allen,

Thank you for your input. I hope that is just a random fluctuation.
I will retest to try to eliminate this possibility. Is there a consensus threshold value for uPSA that should automatically trigger SRT? I keep seeing the threshold value for action being now at 0.03 ng/ml rather than at BCR. Are there any studies that support this choice?

Joe.

another "surgical margin" here. my stats below for you viewing pleasure. G6 at the margin.


I see no reason for you to stray from the 3 mos. PSA tests. A skyrocket is unlikely. But your anxiousness to know what the future holds is understandable I guess.

fwiw....I try and just not give it much thought. And amazingly enough....I do ok on that front....but I've been living with small rises for longer than you have. So maybe I've just got more practice at it than you have so far.

If it's not a lab error....this could go on for many many months...maybe even years....these are *very* small amounts of PSA we're talking about here...

Dear All,

Thank you again for your feedback and advice.

Just sharing information about my consulting expedition regarding a possible low uPSA recurrence that I mentioned a couple of weeks ago in the hope of providing some input to those in a similar situation.

My post-op uPSA tests from LabCorp using the Roche ECLIA method, where reported to be < 0.015 ng/ml until 2016, then on March 2017, I got a report of < 0.006 ng/ml, but my most recent report (August 2017) was = 0.016 ng/ml.

So I consulted first my Urologist and he dismissed the latest result as clinically irrelevant. He suggested that I retest in six months to look at the trend over three consecutive measurements in six-month intervals. Next, I consulted two Radiation Oncologists (RO), one at Hopkins and one at Dana Farber. The RO at Hopkins suggested that I retest in 3 months, and if the result comes above 0.030 ng/ml that I should consider salvage radiation therapy (SRT), as per recent studies by Kang, et al., J Urol. 2015 May ; 193(5): 1532–1538. (I still have to read the research article in detail). The RO from Dana Farber also indicated that this single result is not clinically relevant, and that I should look at the trend of three consecutive measurements performed over three-month intervals. If the uPSA consistently increases and reaches 0.040 ng/ml, he said that I should come see him. He pointed out, though, that the penile urethra is known to produce up 0.040 ng/ml of PSA in serum. Apparently there are even circadian variations of PSA in serum at the level of 0.010 ng/ml.

After these consultations, I embarked into some reading about the Roche ECLIA methodology, the Roche machines and reagents that are used to perform uPSA measurements. I learned that the coefficient of variation is about 40% at the manufacturer's limit of detection of 0.014 ng/ml. This is a huge variation (large error bar) and thus very imprecise! In addition, Roche reported the coefficient of variation to be 20% at the uPSA level of 0.030 ng/ml.

Are there any other methods, machines or reagents used for uPSA measurements in serum, where the coefficient of variation is smaller (say 5% or 10%) when the uPSA is in the range of 0.014 ng/ml to 0.030 ng/ml?

For now, I will follow the advice that I got from my last consultation, retest every three months, look at the trend, and if the uPSA reaches 0.040 ng/ml, I will head to Dana Farber for SRT.

Again, thanks to all for input, suggestions and support!

Joe.

Hey robot

You've put a lot of effort into this. I think the take home is: large error bar. On top of all the good info about how various things affect the PSA.

Rather than look for a more precise test, which is only going to make you miserable in its own way, why don't you look at a book like Statistics Done Wrong (Alex Reinhardt) and/or take an online statistics course? Put all that energy into something that will help you interpret results in the future.

Please don't misinterpret this - you got good info from your extra consults, and if it made you more comfortable, it was money well spent. But your surprise over the large error bar says maybe you are expecting too much from data in general. You might be (paradoxically) happier if your expections better matched reality.

Hi robot,

We have similar uPSA fluctuations so I decided to post my readings for you, see below my signature.
The difference is the Gleason so your fluctuation is indolent.
I am happy with my results until now but I don't understant the fluctuation. It can be the imprecision of the assay for this very low uPSA level(<0.03), non-prostatic PSA-generating tissue or prostatic tissue that has been left behind