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Post Surgery Moving PSA Feast - Any Other HW Members with Same? (plus the Vitamin B question)...

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Posted 8/18/2017 10:55 PM (GMT 0)
Hi All

I was pondering Keysailfisher's (G3+4) recent post about his awesome 7 1/2 year post-surgery results (undetectable at <0.01). In his signature, it shows the following:

PSA 3/29/10 <0.01
PSA 6/23/10 <0.01
PSA 9/16/10 <0.01
PSA 1/10/11 <0.01
PSA 7/12/11 <0.01
PSA 1/16/12 <0.01
PSA 1/14/13 <0.01
PSA 1/15/14 0.02
PSA 1/29/15 0.06
PSA 8/04/15 0.04
PSA 8/9/16 0.05
and now back to <0.01.

So... my question is - with everything I've read about 0.03 being predictive of BCR (Kang et al) with a pretty high degree of accuracy, the above results would appear to be an outlier. Or... are they?

Have any other guys here had such a variance in their PSA post-surgery - i.e. going up then back down again for no apparent reason? Would be very interested to hear about this.

Also, I read somewhere here recently, that large levels of vitamin B complex can also raise PSA readings on certain assays (can't remember the exact reason). So does that mean the vitamin, or whatever the particular ingredient is, is actually raising the (real) PSA, or rather, does it mean that particular ingredient is just 'tricking' the assay into thinking it is some kind of PSA and artificially elevating the readings?

Best to you all.
Jaybee&GG
Posted 8/19/2017 1:50 AM (GMT 0)
Jaybee&GG,

Jaybee&GG said...


Have any other guys here had such a variance in their PSA post-surgery - i.e. going up then back down again for no apparent reason? Would be very interested to hear about this.

Well, mine got to .027 before seemingly retreating again to around .018 or so. Yesterday, I posted my results from monitoring my uPSA over about last six months. Please see near end of my ongoing thread:

www.healingwell.com/community/default.aspx?f=35&m=3787667


Jaybee&GG said...

So does that mean the vitamin, or whatever the particular ingredient is, is actually raising the (real) PSA, or rather, does it mean that particular ingredient is just 'tricking' the assay into thinking it is some kind of PSA and artificially elevating the readings?

I think it's the latter ("tricking"). Please see the sections "An Issue with Assays" and "Biotin at a Glance" in the following link, which seems to be thyroid test related but generalizes to similar assays, of which uPSA is one:

endocrinenews.endocrine.org/january-2016-thyroid-month-beware-of-biotin/



Jaybee&GG said...

So... my question is - with everything I've read about 0.03 being predictive of BCR (Kang et al) with a pretty high degree of accuracy, the above results would appear to be an outlier. Or... are they?

Here is an interesting explanation of the various "cutoffs":

www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/64061

Specific to your query about the .03 cutoff, this quote therein seems to say that the .03 is a very good, but not perfect, predictor for 5 year BCR:

"In the same study a cutoff of 0.03 ng/ml also predicted BCR independent of clinicopathological factors and BCR-free survival at 5 yrs was 90.8% for patients with a PSA post-RP of less than 0.03 ng/mL and 26.9% for patients with a PSA post-RP of greater or equal to 0.03 ng/mL.(1)"

The study (1) they refer to is the Zhang study found in J Urol 2016 Feb.


Hope this helps a little. I, too, am trying to decide when to pull the trigger on SRT, and it is not an easy one.

Robert
Posted 8/19/2017 3:02 AM (GMT 0)
Robert, thank you SO much for an incredible, detailed response. I am very grateful to you for taking the time to provide such extremely useful information. Not sure where I got Kang, rather than Zhang - can't even blame auto correct for that one!
I wish you the very best with your decision making and will watch your story with continued interest.
Thank you again.
Jaybee
Posted 8/19/2017 12:07 PM (GMT 0)
Jaybee&GG,

No problem, I had those materials at hand anyway, since it is a topic near and dear to me right now!

You are not confused. There are two related studies from a couple years ago, with authors whose names sound similar. Probably more such studies by now (2017). Others on this forum may also want to contribute, as they are extremely well versed in the statistics and underlying methodologies. Sadly, I am not.

I think there are a few other forum members that have had the unusual up, then back down, uPSA swings. Just cannot recall their forum names...

Here are summaries of the two studies mentioned, by Kang and Zhang:

/www.ncbi.nlm.nih.gov/pubmed/25463990?dopt=Abstract

/www.ncbi.nlm.nih.gov/pubmed/26307160

I wish you good luck in your decision, too, and a great weekend.

Robert
Posted 8/19/2017 1:41 PM (GMT 0)
ferretx had a similar situation apparently, which I noticed in his signature as you can see below. I asked him if he had any idea why such variations without any other treatments except surgery far as I can tell. But have not heard back yet. Different labs? Notice he got all the way up to +.06 before falling back to <.01, and has had more than one swing up and back down over the years.

www.healingwell.com/community/default.aspx?f=35&m=3897998&p=3

ferretx said...
Posted 8/17/2017 4:46 PM (GMT -6)
Ahh, yes. Turmeric with the black pepper chaser; 600mg/day. And sulforaphane, 400mcg/twice a day. And since I am meat free, I do B-12, 1000mcg daily. Yum, cinnamon flavored!Age @DX 59y, DRE negative, PSA 4.6. One year earlier 3.6.
Biopsy 4 of 12 cores positive (5-10% core volume, left side only), Gleason 3+4=7, Stage T1c
open prostatectomy at University of Washington 7-2013, Mar-, SV- Sept 2013 <0.01
Feb 2014 =0.02
June 2014 <0.01
Nov 2014 =0.03
March 2015 =0.04
June 2015 =0.03
Sept 2015 <0.01
Feb 2016 =.06
Aug 2016 =<0.01
Feb 2017 =<0.01

Posted 8/19/2017 1:52 PM (GMT 0)
All of this PSA anxiety goes away if you use the standard PSA measurement and not the ultra-sensitive test...If you feel this will put you at greater risk of dying from prostate cancer, I don't think that has ever been demonstrated...Starting salvage treatments sooner just degrades your quality of life sooner..But does starting these treatments sooner rather than later improve mortality by any measurable degree? Lets hear what others have to say......
Posted 8/20/2017 5:04 AM (GMT 0)
Hey Billy Bob:
I have at times agonized over my low level PSA bouncing post surgery. I can say that where I live in central Washington state lab services have been changing ownership over time. Try as I might I had great difficulty pinning them down just where my sample were being analyzed. My best guess was 3 different locations with all the attendant machine and reference standards differences that go with that. Last year I got a letter from the lab which seemed to have taken over in this area that 'new' reference standards were now in effect and that they were not comparable to past tests (at least that is what I think they were trying to communicate!!). I wasn't going to complain as the last two tests listed in my signature were <0.01. I have just had another test last week and it came back 0.01 (no <). I finally just accepted that there would be no proof of recurrence for me until a clear upward trend was shown by 3 consecutive tests and that I wasn't 'going to the bank' unless at least 2/3 were above 0.05. Every PSA test still drives me crazy but that's the world I live in. If the demon is still there it will show itself eventually.
Kelly
Posted 8/20/2017 11:32 AM (GMT 0)
I pulled the trigger on SRT when my PSA went from .01 in December 2016 to .05 in June 2017. Maybe it would have gone back down again if I had waited, but I didn't want to wait three months and then find it had doubled. Plus, I had some adverse pathology from my surgery and some doctors thought I should have initiated adjuvant RT. I think that how you respond to a still low but rising PSA depends a lot on the individual circumstances. If I had gone 3 or 5 years post-surgery with undetectable PSA, I would have been slower to initiate RT. But my PSA began to rise from undetectable only 3 months post-surgery. After two consecutive rises, I had had enough.
Posted 8/20/2017 11:54 AM (GMT 0)

Jaybee&GG said...
Hi All

I was pondering Keysailfisher's (G3+4) recent post about his awesome 7 1/2 year post-surgery results (undetectable at <0.01). In his signature, it shows the following:

PSA 3/29/10 <0.01
PSA 6/23/10 <0.01
PSA 9/16/10 <0.01
PSA 1/10/11 <0.01
PSA 7/12/11 <0.01
PSA 1/16/12 <0.01
PSA 1/14/13 <0.01
PSA 1/15/14 0.02
PSA 1/29/15 0.06
PSA 8/04/15 0.04
PSA 8/9/16 0.05
and now back to <0.01.

So... my question is - with everything I've read about 0.03 being predictive of BCR (Kang et al) with a pretty high degree of accuracy, the above results would appear to be an outlier. Or... are they?

Have any other guys here had such a variance in their PSA post-surgery - i.e. going up then back down again for no apparent reason? Would be very interested to hear about this.

Also, I read somewhere here recently, that large levels of vitamin B complex can also raise PSA readings on certain assays (can't remember the exact reason). So does that mean the vitamin, or whatever the particular ingredient is, is actually raising the (real) PSA, or rather, does it mean that particular ingredient is just 'tricking' the assay into thinking it is some kind of PSA and artificially elevating the readings?

Best to you all.
Jaybee&GG

When Keysailfisher went from <0.01 in January of 2013 to 0.02 in January of 2014 it looks like the next PSA test was a year later. Is it ok to wait that long before testing again once you see a change?
Posted 8/20/2017 2:02 PM (GMT 0)
When my PSA went from <.02 to .02, my dr told me to retest in 3 months. He also said he would normally have me retest in 6 months (which was my then current cycle) but he's saying 3 months only because he new I was very nervous.

@ferretx, what did your Dr say about the fluctuation from <.01 to .06 and back again?
Can that kind of fluctuation really be a difference in lbs? I could see ..01 to .02, or maybe even .03, but .06?
Posted 8/20/2017 2:12 PM (GMT 0)
Prato, you're supposed to be taking a break! ;)
Posted 8/20/2017 2:14 PM (GMT 0)
Yeah, I'm trying. I stopped one forum. Can't seem to get myself to talks a break from this one.
OCD
Posted 8/20/2017 2:41 PM (GMT 0)
Prato: The 0.06 was termed an outlier and retesting did show that. But, needless to say it sure got my attention. Moral of the story is don't rush to judgment on any one PSA test. Look for a trend.
Posted 8/20/2017 3:01 PM (GMT 0)
Thanks Ferretx. And yet you also had a .04 and a .03. It amazing how it bounces around. Hope you stay in that low range or less forever.
Posted 8/20/2017 7:45 PM (GMT 0)

ferretx said...
Hey Billy Bob:
I have at times agonized over my low level PSA bouncing post surgery. I can say that where I live in central Washington state lab services have been changing ownership over time. Try as I might I had great difficulty pinning them down just where my sample were being analyzed. My best guess was 3 different locations with all the attendant machine and reference standards differences that go with that. Last year I got a letter from the lab which seemed to have taken over in this area that 'new' reference standards were now in effect and that they were not comparable to past tests (at least that is what I think they were trying to communicate!!). I wasn't going to complain as the last two tests listed in my signature were <0.01. I have just had another test last week and it came back 0.01 (no <). I finally just accepted that there would be no proof of recurrence for me until a clear upward trend was shown by 3 consecutive tests and that I wasn't 'going to the bank' unless at least 2/3 were above 0.05. Every PSA test still drives me crazy but that's the world I live in. If the demon is still there it will show itself eventually.
Kelly

Thanks, Ferretx, that explains it! Apparently, different labs are the answer to why so much up and down. If all one has to do to cause a PSA to go up or down by a factor of 6+(.06/<.01), it surely makes me wonder about how much importance I put on small increases even from the same lab. I suspect the results can vary enough from one machine on different days to get our attention, and if you switch labs all bets are off.

Post Edited (BillyBob@388) : 8/20/2017 1:48:24 PM (GMT-6)

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