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After 6 years PSA shows small rise from .01 to .02 to.03

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Posted 1/30/2015 4:04 PM (GMT 0)
Hey Jeff, I kind of figured using .01 readings from 2009 wasn't kosher. But it was kind of fun to come up with a PSADT over six years, anyway.
Posted 1/30/2015 4:10 PM (GMT 0)
Wow Rob, we do have similar numbers and history. Your Gleason is higher than mine but I had positive margins, so that makes us even more comparable. Let's stay in touch.

The oncologist who did my operation thinks there is less than a ten percent chance I am looking at BCR. He also thinks that if I am, it's much more likely than not that it will be an indolent version of the cancer. It's interesting that your doctor is already considering radiation and mine thinks it's much more likely my PSA rise is healthy tissue growth. Of course he did say his opinion can change based on future PSA readings.
Posted 1/30/2015 6:25 PM (GMT 0)

Bucky said...
I do have a question. There are so many studies with so many conclusions that partly overlap and/or contradict each other that for a neophyte it is hard to determine exactly what is happening. For example, in one of your articles you described a UCLA study that suggested a reading of uPSA of >.03 or =.03 at any time was a virtually 100% accurate predictor of BCR. On the other hand the Koulikov study you referred to in your post quoted above suggests that uPSA of .03 or lower for three years is an almost perfect indicator that BCR will not occur.

My PSA readings for the first three years post RP never exceeded .01 and thus puts me in the no BCR group according to the Koulikov study, but my .03 reading this week at 77 months after RP puts me into the BCR group of the UCLA study. And yet both studies show enormously high predictive properties. What should I be taking away from these apparently strongly conflicting results?

So you're characterizing 0.03 plus or minus a fraction as "strongly conflicting?" I'm actually amazed that they're so close. The patient characteristics in the two studies were very different. And I think you should consider how well you fit in. The UCLA study included 81% of men with GS≥7 and over half were stage T3. They looked at uPSA at 4 points in time ranging from 3 months to 2 years after surgery to see whether it predicted BCR. It did.(You are well beyond that time frame, so if you look at your numbers for the first two years - you fit into the group that never progressed.). The Koulikov study included some men who did not have aggressive post-op pathology. They looked at whether the first 3 years of uPSA could predict BCR. It could. Again, looking at your first 3 years of uPSA clearly puts you in their "undetectable PSA" group. It seems to me that Koulikov is particularly apt for your case, and is very good news.

Keep in mind too that these studies are retrospective, and are subject to selection bias. It's the best we have for now while we await results from randomized clinical trials.

- Allen
Posted 1/30/2015 6:40 PM (GMT 0)
Allen, how much credence can you put into a non randomised trial? Are they more or less info to digest?

Cheers, Doug
Posted 1/30/2015 7:21 PM (GMT 0)
I don't know how to quantify that, Doug. The big risk in a non-randomized study is selection bias - the ones who got the treatment may have been different in some way. Also, it can only demonstrate association but not causation. Often, though, it's the best we have and the best we'll ever have. I don't know what you mean by "more or less info to digest."
Posted 1/30/2015 7:27 PM (GMT 0)
Thanks Allen, that answered it. If a trial has bias and your circumstances meet that bias it could be helpful to you. If you don't meet that bias it's nice to know stats. Over simplified!

Cheers, Doug
Posted 1/30/2015 7:53 PM (GMT 0)
Allen, thanks for the response and the clarification. I wasn't referring to .03 when I said the studies came up with conflicting conclusions for my history. In the detail of the UCLA study there was a line that said that a reading of .03 at any time was a strong predictor of BCR. Since I have recently had a .03 reading that caught my attention. I think where I may have gone wrong is in not recognizing that "any time" in that statement was limited to the first two years of PSA readings post RP.

It's great to have guys on here you can get insight from. It's much appreciated.
Posted 2/21/2015 2:22 AM (GMT 0)
My boyfriend had his surgery October 2013. He was Gleason 6 which was confirmed from pathology report. I did not get to read the pathology report, but remember boyfriend reporting that doctor said, it was great. There were no problems reported, I assumed it was organ confined from that statement. Last PSA test was .01 (August, 2014). Current PSA is .02. The doc told him not to worry, but if it rises this August, it may indicate a problem. I truly was not expecting these numbers based on the fact he was a Gleason 6 and was told his pathology report was good. I have been scouring the web for info. He is only 50 now, so really hoping the next reading stays at .02 or lower. Buckey24 and rob2, would like to continue to follow your next PSA results.
Posted 2/21/2015 3:49 PM (GMT 0)
bumping Babs83, new member
Posted 2/21/2015 10:02 PM (GMT 0)

Bucky24 said...
bucky24.....I do have a question. There are so many studies with so many conclusions that partly overlap and/or contradict each other that for a neophyte it is hard to determine exactly what is happening. For example, in one of your articles you described a UCLA study that suggested a reading of uPSA of >.03 or =.03 at any time was a virtually 100% accurate predictor of BCR. On the other hand the Koulikov study you referred to in your post quoted above suggests that uPSA of .03 or lower for three years is an almost perfect indicator that BCR will not occur................
The Koulikov study Allen referenced used a cutoff point of >.03, not =.03. Also, the study is based on PSA readings for the first three years after RP. The conclusion is that PSA readings of .03 or less for every reading in the first three years after RP predict a very small chance of BCR. My PSA never rose above .01 on any reading during the first three years, so people with my history would definitely have been in the "undetectable PSA group". On the other hand the UCLA study I mentioned suggests any reading at any time of .03 or higher predicts BCR with perfect accuracy. Maybe I am reading all this wrong, but it appears that for my history, the two studies give completely contradictory results................


Shaba.Doug said...
Bucky, that is the conundrum isn't it, what/who do you believe? I've grown so cynical over the years it's bordering on the ridiculous but it has certainly made me more pragmatic. They were certainly right when they coined the phrase "don't believe everything you read". Just as important "don't always believe what you want to hear". But I think you already know that. Just some more random thoughts!

Cheers, Doug

Bucky, all I can say is "welcome to the world of contradictory studies and contradictory advice based on them!". WhoooHooo! There have been quite a few discussions around here lately regarding contradictory studies. It makes me question: once we finally get the RCTs on all these different approaches that may or may not help, well, can or do different RCTs ever contradict? If they do, then who the heck are we going to believe?

But if I am understanding your situation: In March of 09, you got your 1st increase from <.01 to an actual .01. Then, for the past 6 years you have oscillated from = to .01 to <.01, up and down over the years.

So though the readings have varied from below .01 to = to .01 all these years, whatever benign or malignant G6 ( or possibly a bit of G7/tertiary?) tissue that was left behind has finally managed to reach that worrisome figure of = to .03?

Like you said, by one study you should never BCR, by another you probably will BCR? You could try to guess which study had the most patients most resembling you.

Seems to me you just don't know. Which study do you prefer? smilewinkgrin I don't know, it's hard to figure out, is it not? It can be so frustrating, that as you can see from Doug's post, it has driven him to cynicism! I'd just say try not to worry and wait and see what those future PSAs are going to do. It has taken them a long time to claw their way back up to .03, plus many times in the past they have turned around and headed south again. Seems to me hard to say they won't do the same thing again.

Just think back to over 6 years ago. With that G6 and PSA 5.8/T1C, today you might be even a bit more likely to choose AS, though I guess that tertiary 7 confuses things a bit. But there is another thread right now about new outlooks on even G7s and AS I believe. Still, if a person with your stats was just starting, you might well choose AS and that is with the knowledge of the full tumor load being present- enough to(along with healthy prostate tissue) run your PSAs up to 200 times higher than it is right now. Well, aren't you kind of in the same position as you were then? I.E. a possible AS but starting with a tumor load that was reduced to almost zero 6 years ago?

So maybe just consider yourself AS until significantly more evidence is available?

Bill
Posted 6/1/2015 5:32 PM (GMT 0)
A couple of posters asked that I keep them posted on what has been happening. so here goes. After my late January PSA test came back at .03, my doctor scheduled a follow up PSA for June 1 (today). Today my PSA read .02, which he said is a good indication (but not guarantee) that the small rise in PSA I had experienced recently was just a little growth in a small amount of benign tissue left behind from my prostate operation seven years ago. He scheduled a follow up PSA test in six months and told me that if that one remains stable we would go back to annual tests.

While I had his attention, I asked him a couple of questions that I thought might be of interest to some of the people on this forum.

1, My post op report from seven years ago said that my cancer was Gleason grade 3-3 tertiary 4. He said he considers that Gleason 3-4 and that the current norm in the profession is that even if the tertiary cancer is a very small fraction of the cancerous cells it is now considered the second number in the Gleason score. He then laughed and said that will probably change again in six months as new research is reported.

2. I mentioned that when I used the Sloan Kettering nomograms to predict the likelihood that salvage radiation would succeed for me in my situation with my numbers, my chances of success were higher with positive margins than without. This seemed counter intuitive to me but he confirmed that it is the currently prevailing accepted research in the profession.
Posted 2/11/2016 6:58 PM (GMT 0)
Just an update since my last post. My six month PSA test taken in late January came back at .03. That's up .01 from the June 2015 test, but the same as the January 2015 test. Given this result my doctor feels that the increase from .01 in November 2013 to .03 two plus years later is almost certainly just a little growth in benign prostate tissue left behind from the initial surgery seven and a half years ago. He put me back on an annual checkup schedule.

So for anyone whose PSA has started to show a slight increase years after surgery, this is one example that it does not necessarily mean you still have cancer in your system.
Posted 2/11/2016 9:32 PM (GMT 0)
Thanks for the update and happy you had good results on your latest tests.
Posted 2/11/2016 10:12 PM (GMT 0)

bucky24 said...
Just an update since my last post. My six month PSA test taken in late January came back at .03. That's up .01 from the June 2015 test, but the same as the January 2015 test. Given this result my doctor feels that the increase from .01 in November 2013 to .03 two plus years later is almost certainly just a little growth in benign prostate tissue left behind from the initial surgery seven and a half years ago. He put me back on an annual checkup schedule.

So for anyone whose PSA has started to show a slight increase years after surgery, this is one example that it does not necessarily mean you still have cancer in your system.

OK, Bucky, that is good news seems to me. In case I have not said so earlier, I would like to say now: Even if you do BCR some day, that is not the same thing as ever metastasizing and even less is it the same as having serious trouble and even death from PC. (Obviously you know that I am just emphasizing it). As your doc considers you a G7(3+4) due to the tertiary 4, keep in mind that with your risk, these days, even 3+4s are going AS sometimes. And consider the tiny amount of people from AS programs who ever actually MET. And these are people who never even have their tumor removed, the vast majority still did not MET. So seems to me the odds are greatly in your favor, which I think you already know. yeah

I would like to ask you about something you said in an earlier post:
"In the detail of the UCLA study there was a line that said that a reading of .03 at any time was a strong predictor of BCR. Since I have recently had a .03 reading that caught my attention. I think where I may have gone wrong is in not recognizing that "any time" in that statement was limited to the first two years of PSA readings post RP.".

Is that correct? (I did not see where anyone corrected you) I.E., is it correct that the prediction of BCR for someone having > than or = to .03 at any time" actually means at any time in the 1st two years, and NOT at any time ever?
Posted 2/12/2016 2:50 AM (GMT 0)
hey rob, i remember that we had similar numbers and that our psa started rising about the same time. i see you had SRT. after my first .03 reading my doctor wanted to hold off for a while to see if my psa kept rising. since it has stayed stable for over a year he thinks i am in the clear. if you don't mind sharing, what prompted you to go forward with SRT? since we have similar histories i'm interested in your decision making process.

billybob. thanks for the nice comments. as far as the ucla study, i read that quite a while ago and cannot remember the specifics. i'll try to find it again and respond. however, allen knows a lot more about this subject than i do, so i'd trust what he posted over anything i can come up with.
Posted 2/12/2016 6:27 PM (GMT 0)
The main reason I moved forward with SRT was the fact I was a Gleason 8. I could have waited but decided to move forward.
Posted 2/7/2018 11:06 PM (GMT 0)
I am 18 months post surgery. After reading this post and just having my PSA checked for the 3rd time post RP w./lymph node dissection, my latest test came back at: After reading this I though the lab made and error in that my p.009 ng/ml should have read <0.009 ng/mL However, it doesn't appear to be correct. I got a call from my Urologist office right after they got these results and want me to come back in 3 months to test again. I am worried, very worried. I don't know how far of a jump from non detectable at <0.015 to 0.009?

Thanks,
Brian

My latest one from yesterday shows:

Patient: Brian Tinsley
ID: 1100 03312901260
Note: All result statuses are Final unless otherwise noted.

Tests: (1) PSA, Ultrasensitive W/O Serial (140731)
PSA, Ultrasensitive 0.009 ng/mL 0.000-4.000
Roche ECLIA methodology.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.200 ng/mL or greater followed by a subsequent
confirmatory PSA value 0.200 ng/mL or greater.
Values obtained with different assay methods or kits cannot be used
interchangeably. Results cannot be interpreted as absolute evidence

Had 2 prior PSA tests, one in 2016 and one in 2017, both came back at : Ultrasensitive <0.015 ng/mL 0.000-4.000
<Tests: (1) PSA, Ultrasensitive W/O Serial (140731) PSA, Ultrasensitive <0.015 ng/mL 0.000-4.000 Roche ECLIA methodology. According to the American Urological Association, Serum PSA should decrease and remain at undetectable levels after radical prostatectomy. The AUA defines biochemical recurrence as an initial PSA value 0.200 ng/mL or greater followed by a subsequent confirmatory PSA value 0.200 ng/mL or greater. Values obtained with different assay methods or kits cannot be used interchangeably. Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease
Posted 2/7/2018 11:11 PM (GMT 0)
I hope you don't worry. That's well within background PSA levels.
Posted 2/8/2018 12:04 AM (GMT 0)
hey tennis23,

i know it is easy to worry about every number you get. boy, do i know. but yours sound very good to me. if i am reading your results correctly you had two previous results with PSA less than .015. this recent one came in at .009.

.009 is less than .015. it sounds like they simply changed the way they report stuff. at my hospital (kansas university hospital) any reading under .01 is considered undetectable. my urologist said the kansas university test goes to three decimal places but they won't report anything less than .01 because it's noise level stuff that causes more anxiety than it's worth.

two key points here:
1. .009 is less than .015. if they had reported results the way they did on your first two tests you would have gotten another less than .015 result.
2, if this is bothering you i would call your urologist and ask him what the .009 means. until then i wouldn't worry, or at least try not to worry. as best as i know readings of .009 are to be celebrated, not feared.
Posted 2/8/2018 1:19 AM (GMT 0)
Hi.. I got a call from my Urologist and they said the same thing that the LabCorp changed the way that they are now reporting their numbers. So, I was a little re leaved and feel better. But this support site is fantastic. I think that if my next psa in 3 months says the same, like you say, the new undetectable will be 0.009.

Kind Regards,
Brian
Posted 2/8/2018 3:59 AM (GMT 0)
that's great news. you've burned up some hours worrying. now it's time to go and celebrate .009. it's a good day.
Posted 11/30/2018 9:59 PM (GMT 0)
We are experiencing a little bit of a roller coaster of emotions right now. The annual PSA test I took this past Wednesday came back at .05. That is the highest result I have gotten in the ten years since my RP. I had been less than or equal to .01 for the first five years of follow up tests before increasing to .03 in year six and then .04 in year nine. My urologist has consistently said he thinks the PSA numbers are likely just a little bit of benign tissue growth. But at .05 is that still really likely? It's only one test and PSA results do bounce around at these low levels, but the pattern has been pretty well established over the past five years.

As I understand it you can't really calculate doubling time on numbers so small, but I did anyway. Using the doubling time function on the Sloan Kettering site my PSADT is between two and four years, depending how far back I go with my PSA test results.

I see my urologist Monday for my annual meeting. My best guess is that he'll tell me to take another test in six months rather than what we have been doing recently, which is once a year.

I know the level is still low and I know it is growing slowly and probably this result shouldn't be bothering me. But it does. So any feedback would be appreciated.
Posted 11/30/2018 10:37 PM (GMT 0)
benign tissue is certainly a real possibility. The increase in PSA is steady, but very slow. At a mostly G6, you're in a lower risk group, so another test in a few months would be wise.

I wouldn't be thinking about needing any follow on treatment right now, but if it gets any higher, you may, might want to consult with an RO for SRT.

Sadly, I think you're in that awful waiting game.

Andrew
Posted Yesterday 7:40 PM (GMT 0)
Hi bucky24,

bucky24 said...
probably this result shouldn't be bothering me. But it does.

Yeah, mine starting to bother me, too. Just got a bad reading yesterday, history below. I have my annual with urologist in two weeks. Maybe we can post afterwards just for info. Would like to know what yours says. I pretty much know what mine will say. He was kinda perturbed last Dec. to find out I was even self-testing with uPSA. He only uses yearly standard (.100) test, on theory a patient wouldn't do anything before that level anyway, so why bother? I don't agree, I wanna know, but he does supply my T script and supplies, so I'll have to bite my tongue this appointment. I want to know because I need time to scope out/set up better radiation facilities than can be had in my mid size town. If it comes to that.

I will probably just stop injecting T for a couple months (Dec/Jan) and see if my uPSA drops, like it did last year (summer/fall) when I tried same approach. Got uPSA to drop from .027 to .017 doing that. Just nobody knows what is really going on. So discouraging.

Results this year:

2018/01/12: uPSA = .026
2018/03/05: uPSA = .032
2018/04/04: uPSA = .028
2018/06/15: uPSA = .029
2018/08/22: uPSA = .030
2018/11/02: uPSA = .034
2018/12/01: uPSA = .048

Please post your doc's ideas.

*** oh, btw bucky24, on your positive margins at bladder neck, how many were there and did you ever get a pathologist's reading on the gleason at those margins (at RALP or 2nd opinion path)? -- sorry if you stated this before...***

Thanks,
Robert
Posted Yesterday 9:20 PM (GMT 0)
I am also watching this study closely. My early psa tests were<.1. I was not comfortable with a lab test of <.1...I changed labs. my 9 month psa was .03 and 15 month psa is .08. I had Negative margins. I am going to get another psa in 3 months even though my uro scheduled my next psa in 6 months. Worried.
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