Latest PSA Test 2 year mark

I just had my appointment with Dr. James Porter's assistant Mitchi (sp) and originally it was to try an injection of one of the trimix , started with an A I believe. I got the shot and a slight, ever so slight to almost non existent erection. So, she said to try .35 next time. We started at .25, but based on nothing happening, she said to try .35... However, I am not sure if the shot route is for me. Was thinking of perhaps the MUSE? It's just been 2 years not w/o any erections, except one. My real concern is that she ordered a PSA and:

Patient: Brian Tinsley
ID: 1100 22112905480
Note: All result statuses are Final unless otherwise noted.
Tests: (1) PSA, Ultrasensitive W/O Serial (140731)
PSA, Ultrasensitive 0.014 ng/mL 0.000-4.000
Roche ECLIA methodology.
According to the American Urological Association, Serum 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
=====================================
Back in 2017 I had this:
Patient: Brian Tinsley
ID: 1100 04512915410
Note: All result statuses are Final unless otherwise noted.
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.

Note: An exclamation mark (!) indicates a result that was not dispersed into the flowsheet.
Document Creation Date: 02/15/2017 5:11 AM
_______________________________________________________________________
(1) Order result status: Final
Collection or observation date-time: 02/14/2017 15:00
Requested date-time:
Receipt date-time: 02/15/2017 00:00
Reported date-time: 02/15/2017 08:08
Referring Physician:
Ordering Physician: J Porter (jrp)
Specimen Source:
Source: 1100
Filler Order Number: 04512915410 LAB
Lab site: Performed At: SE, LabCorp Seattle 550 17th Avenue Ste 300 Seattle, WA 981225789 Daniel Toweill
MD Phone: 2068617000
-----------------
The following non-numeric lab results were dispersed to
the flowsheet even though numeric results were expected:
PSA, Ultrasensitive, <0.015
James R Porter MD ( Swedish Urology Group )
Lab Report: PSA, Ultrasensitive W/O Serial ( 02/14/2017 )
P

My one inbetween these 2 was I thought: 0.009

I don't know what do think as the comments from Dr. Porters person was this:
Hi Brian,
PSA from yesterday 0.014. Still low. Hard to tell if it is increasing at this low number.
We need to keep an eye on this every three months or so. Doesn't have to be exact but can't forget about it. We can talk more when you're here next month.

Michi

Michi E Nair PA-C
August 10, 2018 9:20 AM

Tennis,

It looks like you have a little residual PSA since surgery--which is not great, but not bad either. The good news is that your PSA is stable at a low level--which is great news. Keep an eye on it, and if it starts to move, then you can do something.

As far as the trimix, etc, I have no experience to offer.

Brian, you've run into the most irritating part of the ultrasensitive PSA game (yes, I'm calling it a game, because that is what it is). It is this: every instrument builder (and these are sophisticated electronic gizmos, not some lab tech with a microscope or some other old-fashioned lab device actually running an analysis), is trying to build a new machine with a lower detection limit, as if that is somehow 'better'.

It means, in short, that the first test you had, was done on a machine with a detection limit of 0.015 ng/ml of blood. Now, there is a new (expensive) machine that has a detection limit of perhaps 0.010, and your reading came in a 0.014. Detectable (or else it would have been reported at <0.010), hence the lack of the "<", but still less than what you got the first time. All the "<" means is that 'we can't tell how much lower that our detection limit can read it is, so we just say it is less than"

It's kind of like having an outdoor thermometer on your house that reads from -10 to 110. Well, in the dead of winter it might well be wound all the way down to the little peg below -10. How cold is it? Well, truthfully, you don't know. It's just somewhere below -10. Either way, it's d___ned cold.

In truth, the doctors aren't going to do anything until you get a reading above 0.1 that repeats over a period of time anyway (see Pratoman's thread about recurrence), so it's almost academic whether the difference between <0.015 and 0.014 is meaningfull or not. I'm waiting for the day that they come out with an instrument that can supposedly read down to 0.0001 or something: which would be literally the ability (claimed) to measure a single molecule of the PSA protein in a vial of blood. Who cares?

Tennis

The 1st Trimix dosage I tried did nothing i was almost up to a full 10 units on the one needle i was given so I went back to my Urologist. She called into a special compounding pharmacy and spoke to the pharmacist there. The dosage of meds has been adjusted I do get an erection but now am having issue with the hand i would give myself the needle with.

Do not give up it does work i was close to 14 months without an erection. There are other guys on this forum using Trimix. Muse did nothing for me except hurt my pocket book!

Hey Brian, As your doc says...there's no evidence that your PSA is rising. Every reading you've had is the same reading you had since surgery....that being...."<" (a "less than" sign). .009 is the same as <.015 and .014 is the same as <.015. There's been no change. The reporting has changed. But the evidence not really there to conclusively say that your PSA has risen since your surgery.

That third number is so small that it can vary between two tests given on the same day. Just equipment calibration, and I think hydration, etc....a lot of things makes that third decimal point practically meaningless. That .009 could be rounded to .01. That .014 could be rounded to .01. that <015 may have been a .01. There's just no way to really tell at this point whether your PSA is truly rising or not.

There's guys here that's had your pathology (G9 with good path) and they've lived years with the small amounts of PSA that your tests are showing. It's scary and nerve racking to loose a "less than" sign. For me...it was more traumatic than being diagnosed the first time. Loosing the less than sign after surgery can feel like being diagnosed all over again...only this time...."it's worse"! The feeling is real. However...it's not real to presuppose that you're on your way to a recurrance.

You'll get used to living in 3 month segments or 6 month segments....and as long as there is no actionable point (your PSA is not rising)….life should go back to being more normal for you between tests.

I think I am going to take matters into my own hands, been doing a lot of research and I think I am going to the SCCA and see : https://www.seattlecca.org/physicians/celestia-s-higano as she seems to be one of the leading doctors about the PC research. Granted my PSA was just measured at 2 years with a score of 0.14, that appears to be the minimum detection of these new machines, which most likely means, somewhere the PC Cells are looming? I could be wrong and I hope I am, but I want to give myself the best shot and it looks to me the SCCA site here in Seattle and along with the research, they seem to be on top of the latest clinical trials and treatments. For my own peace of mind, I am going to make an appointment and get a second opinion. Brian

I have an appointment with Dr. Yu at the SSCA here in Seattle on the 28th of Aug. I just want another set of eyes watching over me and a second opinion. Brian

Part of me is angry that my first two tests showed the <0.015 and then my next one at 0.008 and my last at 0.014. I signed up for the Lab Corp website and the first 2 tests show in the grey area which they show as undetectable. But the 0.008 and the 0.014 both show in the middle in a green color. So why is my urologist not taking action when my first psa test from a year ago started to show what appears to be trace amounts of psa? Do I have a right to be concerned with my last two readings as if there is cancer coming back?

Ok I will chill out and try to come at this more even keel

Take it as good news. Retest sometime.

At the ultra sensitive level of testing there is a lot of noise and the assay makes a lot of different. Mostly it's an anxiety generator. You'd need to see a much higher PSA numbers to start to be concerned.

Andrew

yes, do something when you've got a clear sign of rising numbers. you don't have that - you have noisy numbers based on possible lab assay issues.

Wait for the confirmation - at least two verified readings over .015.

what you're doing now is driving yourself crazy.

Andrew

wisdom I've heard before is: Call the RO at .03, start the treatment planning at .05.

Andrew

Gosh....... I hate the internet! Now I stumbled across this site, https://prostatecancerfree.org/prostate-cancer-patients/ and from the results of this site, I think I made the wrong choice with having the Radical Prost. vs the seeds with radiation as far as best long term results success. I have my appointment with Dr. Yu at the SCCA on the 28th. The weird thing is that I got a call from my surgeon yesterday, who basically said to me, if you want, I can hook you up with a Radiation Oncologist here at Swedish to discuss things and he admitted basically that my PSA was creeping up. Which, I thought was interesting at even such a low level. 0.008 to 0.014. Oh well, nothing I can do, its out of my hands, I am just going to get some input from various experts and figure out what route I should go.