First Rise in PSA Four Years Post RALP

I know that this subject has been covered from time to time over the years and now I find that it applies to me. I had been thinking how nice it would be to get another report of <.02 undetectable at four years post RALP but alas, I got stuck with a .03 on the ultra sensitive test. Now I am aware that in some medical circles, .03 is still considered "undetectable" and that the threshold for recurrence is .1-.2.

I am well aware that many of you would "kill" for a .03, but having become so comfortable with an undetectable score for so long, the present change, as little as it might be, does give me pause for thought.

Any new insights on this subject that anyone might care to share with me would surely be appreciated. This forum was always terrific when it came to sharing info.

I had a good outcome and I know that many of you have not. Thanks for being there for "all of us" who made it to "the other side". Any info on current thinking that addresses this issue would be helpful.

Be well!

Clanda, yup sucks to lose the <, no matter what the circumstance.
With that said, I think you should be aware, that some time around March 2017, Dr Tewari switched to labcorp. They said something to me about labcorp buying the mount Sinai lab. Not sure that was the whole story.
What a coincidence, huh?

Guess what... in January 2017, 2 years post op, I went from <.02 to .02. I believe that test was done at Mt Sinai, Tewari's office did the blood draw. In March, when it was time for a 3 month follow up, they told me it was <.1.... I'm like WHAT??? They told me they did not do ultra sensitive PSA because they switched to labcorp and labcorp wouldn't do it for them, but they were working on it. You can imagine how p!ssed I was.
I asked for a prescription and went to labcorp directly fir the uPSA. IT CAME BACK AT .033. 3 months later, again, .033. My next test is in 3 weeks.
BTW, my pathology and yours, are the same...

Around the same time, another member, also a patient of Tewari, had a rise from undetectable. His screen name is Gedman.

Too many coincidences here. I'm starting to wonder if this whole thing isn't somehow lab error related.

I'm sticking with labcorp directly now. Then test down to .006. But I'm thinking if I stay stable at .033, I can deal with that.

Food for thought, good luck

clanda,

Welcome to our little nervous corner of the PCa world. There are a few of us here like you, waiting the jury verdict to see what's next. You can find threads by using the "search" function on "recurrence" or "uPSA", etc. Not sure there is much "new" to add. We have all kinda hit a wall with the research, guesswork, etc. until medical research catches up some, I guess.

One thing I noticed is you apparently have been tested yearly in the fall, is that right? If so, I would vote for one immediate retest now to eliminate a "possible faulty test" situation. But try to stay off of any biotin for three days (i.e., not even multi vit/min pills, unless dr. ordered), test at same time of day as your recent test (diurnal effects?), and make sure you are properly hydrated (because the uPSAs are testing down to "trillionths of..."). I personally also fast "morning of", but that is a personal decision only, just to try to get as accurate a test as possible and weighing TRT and "saturation theory" in my case. (We are all trying to eliminate extraneous issues from a very sensitive test, without knowing much about what those issues might be, sigh...)

Then, I would vote for a couple more, under similar conditions, at three month intervals. The idea is to see where you fit in the following scheme of undetectable, low detectable stable, or low detectable unstable:

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4586061/

Also, because some here have had uPSAs trend up, then come back down and seemingly stay down, three month testing will tell you how consistently close you are to the .03 threshold some doctors view as significant:

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

The above apparently does not apply to you (no + margins) but it gives some detail behind the .03 threshold. Just wondering, did you have a 2nd path done way back?

If your next test in three months shows anything more than a gradual trend upwards, you could start looking around for a good RO, maybe even have an introductory consult, just to get prepared for worse case, like Pratoman did.

Anyway, that's what I'd do in your shoes. Others here will weigh in. Sorry not much else to add. Watch and wait. Kinda sucks, but could be worse, we all know that.

Robert

Sorry you face this news, Clanda -

Some of us appear to be having some success delaying secondary or tertiary therapy with diet and exercise - intending to give our immune systems every advantage.

Maybe it helps - anecdotally seems to and there are many non-quack medical professional advocates.

NOT a substitute for medical interventions... - still those decisions to make.

Best to you -
Wilderness.

Clanda, ok, so you testing at Quest, pretty much blows up my theory.

Read cashless clays thread on PSA and diet. He just commented in it so it should be easy to find on the first or second page.

Re Quest-they make mistakes too. Big ones and little ones. I'm living proof, I once got a 3.8, 3 months after a <.02. Retest came back at <.02. So good you are retesting right away

Guys,

I have again learned that I should NEVER take anything for granted. I had a re-test on my own dime this past Monday of my uPSA and this time it came back <.02 which is what it had been every previous time I checked since my RALP in November 2013...except for my blood test of three weeks ago which was .03

Now while I would like to simply say that there was an error in my most recent "previous result", I'm not so sure and here's why. I think there was a dietary factor involved along the lines of what Cashless Clay has written in his thread on PSA and Diet. I took that previous blood test just three days after returning from Spain with my wife after visiting her family. For ten days I ate a great deal of Spanish ham, chorizo, beef and not so much with vegetables. At home, I live on fish and chicken and almost no beef...plus lots of salads and vegetables. In addition to my increase in uPSA, my LDL cholesterol broke past 100 for the first time in my life giving me a total cholesterol of 179, 40 points higher than one year ago. Except for that interlude in Spain, I watch what I eat.

In the week before the re-test, I had my normal "home diet" without any beef. And now I have my <.02 back.

So all I can be certain of is, don't take everything for granted. And I hope that you all get some luck too as you deserve it!

Be well!

clanda,

I also have my blood tests at Tewari's office. You can check the link below for my PSA history.

The difference between < 0.02 and 0.03 is negligible. It can be as insignificant as the calibration of the machine that performed the test. As Dr. Tewari's staff will tell you, even 0.03 is still "undetectable".

I'm not trying to minimize your concern. As you can see from my PSA history, I've also had a reading at 0.03

Gedman

With the sharp rise in cholesterol, one wonders if they gave you someone else's results. Recent research shows that ingested cholesterol doesn't vary blood cholesterol that much.

I have a related but different problem. I get a positive reading 0.029-0.059 (last one 0.038) on any Siemens assay, but six other assays (including both LabCorp's Roche Cobas and Quest's Beckman Coulter) show undetectable. Go figure.