Should I insist on ultrasensitive PSA test?

If my M.D. were that patronizing, I'd find a new doctor.
Wilderness

I have never used he ultra-sensitive test. I have seen much unnecessary hand-wringing over it on this board due to very minor fluctuations. I question its advantage for most men, but I am sure there is a place for it. TA is knowledgeable about it and when it is helpful.

By the way, you certainly don't need your doctor to approve or order it. Just go to the lab and buy the test.

JeffM said...
So I go tomorrow for my first post-op PSA test. My doctor has already indicated that he intends to do a regular PSA not an ultrasensitive. I haven't yet asked him why, but I suspect he is in the camp of doctors who believe that the ultrasensitive is not really that accurate and can create unnecessary anxiety due to the possible fluctuations.

What do you guys think? Should I insist on an ultrasensitive PSA?

Jeff

Smart doctor! Sounds like you got someone with good experience.

You have no indications for an ultrasensitive PSA monitoring test; there is no benefit for you...they are for men with adverse post-surgery pathology (or predominantly Gleason patterns 4 or 5, irrespective of pathology). Sounds like (looks like, from reading your signature) you've had everything go right and very much as expected. Your upgrade from 3+3 to 3+4 is so common that it is almost typical. Even if you had 3+4 found pre-surgery, you might still be a candidate for Active Surveillance. Ultrasensitive PSA in your case would be a waste of "egrs" (a waste of energy). Great results being continent quickly after surgery. At this point, focus instead on weaning yourself from trimix, but no need to rush...think in terms of the next several months. Glad to hear you are under good care...!




BTW, you are right about the part that ultrasensitive PSA causes undue anxiety in men who have no medical indications for it...the naturally occurring variations in the human biology play havoc on people's minds. There are soooo many examples right here on the pages of HW/PC. But you are not right about any belief that the test is low in accuracy. It's very accurate; but the naturally occurring variability make it not a very precise test...thus the undue anxiety it causes.

Post Edited (NKinney) : 2/1/2018 4:23:20 PM (GMT-7)

Thanks for all the replies. I sent my doc a message on MyChart asking why the standard test vs ultrasensitive. I love the fact that he replies to my messages within a few hours.

His response: "For you, there is no benefit over routine PSA testing. An undetectable PSA is what we are looking for."

Hoping for an undetectable PSA!

Jeff

I think that if you make it your business to become informed about how uPSA can most beneficially be used, and how it can also be abused, you can easily make that call. For men with good pathology, like yourself, the data suggest that the only time that men in your situation should react to uPSA findings is in a very specific situation: a uPSA over 0.03 and rising on two subsequent uPSA tests or a rise of 0.05. In situations where uPSA is below 0.03, or where it is above 0.03 but it is stable, there is no cause for concern. Of course, a super-ultrasensitive test (3 decimal points) is completely unnecessary and should be avoided.

The danger is if you look at, say, a single reading > 0.03 and think you need treatment and develop anxiety over it. Conversely, one can develop anxiety over not knowing exactly what the uPSA really is. So, I think, it depends on you, and you are fully capable of deciding for yourself.

Kcheves,

You had adverse pathology (T3a) and should be using a uPSA. It is definitely not in your best interest to wait for PSA to exceed 0.1. This was most recently demonstrated in the following:

/pcnrv.blogspot.com/2018/01/new-study-adjuvant-radiation-saves.html

I had the ultrasensitive test and continue to do so although if my psa goes past 1 I might forgo it. For me, having the data allowed for a quicker decision to get salvage radiation. You miss out on establishing a trend line, as Tall Allen mentions. Unless you are an excessive worrier, get the ultrasensitive and just recognize that small variations are normal - the accuracy of the test is not so good when psa is very low.

My urologist recently ordered both ultrasensitive and regular, just to see if there is any sort of difference. The answer, at least for Labcorp, is no. 0.398 vs 0.4