Undetectable again, really??

Here are my five post-RALP (8/11/2017) PSAs:

9/25/2017: 0.13 (Diagnostic Laboratory Services, Hawaii -- Siemens Dimension)
10/10/2017: <0.05 (DLS)
1/8/2018: 0.09 (DLS)
1/31/2018: 0.10 (Florida Hospital -- Quest, I think)
2/9/2018: <0.05 (DLS)

How's that possible? Any explanation other than lab error? I've had no therapy other than RALP, though I'm slated to start ADT as soon as the local pharmacy gets its Casodex order in. The main reason for the blood draw was to get an initial T level (431), but my PCP asked for a new PSA as well.

I've been dragging myself to ADT kicking and screaming. Normally a < would be cause for celebration, but it's kinda not helping right now.

SP - if this wasn't so amazing and hopeful, it would be scary. Actually it is scary. I really really really hope the retest comes back < undetectable again. Not to make your life more difficult than it is, but wouldn't it be amazing if you ended up cured just before starting ADT.

Hey SP can you send some of those green smoothies to Minnesota? I'm on board with the other guys let's think positive and say your cured!!!!!

Larry

Saipan,

There is sure something weird going on here, with the test results you documented. Your uPSA was declining, or stabilizing, or undetectable...Whaaaa???

Not that you asked my opinion, but...

If I were you, and I had an extra $100 lying around, and I was anywhere near a decent sized city, I would take matters into my own hands and get a LabCorp uPSA test myself to provide another data point.

(provided you are not in one of these areas: "LabCorp: Online lab testing is prohibited in MA, MD, NY, NJ and RI.")

You could most likely get the blood draw within a day or two and the result back the day after (has almost always been case for me). Nobody except you will see the result (unless you want). No doctor will be informed.

You can find the companies that handle this online testing by googling for something like "walk in" + "lab tests". But basically they are just fronts for LabCorp and Quest. Once you set up your account, you just order your test, pay via credit card, then you immediately get a doctor signed lab order to take to the LabCorp or Quest office, get your blood draw (no appt. needed usually), then they post your results you can see online and print, should you wish to share with anybody.

One warning on uPSA: "No fasting required. Stop biotin consumption at least 72 hours prior to the collection. PSA sampling should not be performed for at least six weeks after prostatic biopsy."

Biotin is B-7, found in many vit/min or health food pills.

I really hope you have been mostly undetectable all along. But, in any case, there have been unusual lab results that guys have posted about on this site. I'm one. My uPSA jumped up and down by about 50% over the last year.

Just seems another data point, done quickly, would add good info without harming you medically.

But that's just me. I'm a little paranoid. "Trust, but verify".

Robert

Thanks for the suggestion, Robert, but that's not an option from Saipan or Guam.
While I was in Orlando last month, I went ahead and had Florida Hospital run a PSA as a cross-check on the numbers I was getting from DLS-Hawaii, my only option in Saipan. FlHosp's 0.10 was consistent with 0.09 from DLS three weeks earlier, and seemed to confirm that DLS's numbers have generally been reliable.
Bottom line is that given pT3a, Gleason 8 at the positive margin, and EPE+, radiation with ADH makes sense even if my PSA is currently undetectable and the therapy should be regarded as adjuvant rather than early salvage.
Allen, DLS has agreed to rerun the test on last week's blood draw but are confident they did not make an error. If it comes back still <0.05, I'm inclined not to do a fresh blood draw. I don't see how it can or should change my decision to go forward with RT+ADT. It can only mess with my mind. If you think otherwise, let me know.

Saipan,
I have no idea, but perhaps the 10/10/17 test was not right. Take that one out, and theres an almost steady drop, which your green smoothies could take credit for. LOL Just be glad it is not a rising 7.2! Also do not fear ADT, its a standard treatment most of us get used to. But heres hoping your next PSA is <,0.01!!

Sorry for your dilemma SP. Come back to FL and we'll test you again. your getting good advise. I tend to think something is going on with your PSA. What I have doubts about is how much any of these readings are really telling us about what the cancer cells are up to. Clear as mud....

BTW my PSA is down to .07 and all it took was two months of ADT

Good luck dealing with this.

Progressing,
When I saw the surgeon last month, he downplayed the EPE and positive margin as minimal. He clearly thinks there’s no need for me to pull the trigger now, but acknowledged that some of his high risk patients opt for more aggressive tx post-RALP.
Let’s see what my RO says when he calls back.

They could have recalibrated or replaced their machines. This illustrates why you should get your tests from the same place under the same criteria if at all possible. I wouldn't personally jump on the ADT bandwagon until I either retested at the same location or got some sort of reasonable explanation. ADT has always scared the heck out of me. I'm not ready for HGTV and the Hallmark channel.

Tom

Pratoman said...
I wouldn't do anything including the nuclear option until I was 150% sure that I was recurring

wouldn't be the first time a cured patient underwent further treatment. That's the only thing we *do* know.

Update: 2/23 uPSA = 0.08. Consistent with January PSAs of 0.09 and 0.10. I'm going ahead with HT+ART/SRT (not sure what's best to call it at this steady PSA level). Getting 3-month Eligard today, radiation simulation 3/6, first of 42 fractions (total 75.6 Gy) whole pelvic 3/12.

Hi SP, In some ways I guess my decision was easier than yours I don't know what I would do in your shoes I guess whatever you feel comfortable with. I will say that I am definitely having a lot more trouble with incontinemce since my SRT. Seems like I don't have much volume anymore I had a cup of black tea last nite before going to bed and I swear I was up every hour made for a long nite.

Larry

Thanks for your reply, Larry. Sorry to hear you're having such trouble post-SRT.
Allen and ddyss, thanks for the encouragement.
I'm going ahead as planned. Here's how I look at it: I have enough high-risk factors, esp. G8 and EPE+, that regardless of the PSA it might be a good idea to do HT+RT now. By the MSK nomogram, my 2-year probability of remaining recurrence-free, absent further tx, is only 51%.
As to uPSA: my own experience, as well as reports from others, persuades me not to put too much stock in incremental changes absent a clear trend. Pre-RP, my PSA was moving fast: 1.8 in Jan 2015, 2.9 in Jan 2016, 7.2 in Apr 2017, four months before RP. That's a dangerous velocity (>0.2 ng/mL/yr), it might have put me around 10 ng/mL had I been tested just before Aug 2017 RP. My first PSA six weeks post-RP was high, 0.13. I now think there's a reasonable probability both my <0.05 readings were outliers (my Saipan blood draws have to be overnighted via Guam to Hawaii for uPSA testing, lord knows under what conditions), and that remaining cancer has been producing PSA in the 0.05 to 0.10 range since surgery. So it's time to do something about. The risk of bad long-term SEs from further treatment doesn't outweigh the reward of a possible cure. At my relatively low PSA, the MSK SRT nomogram doesn't quite fit, but I think the 70% chance of cure that two ROs have quoted me is in the right ballpark. I say go for it.