My First PSA 7 weeks after Radical Prostitechomy with lymph node dissection Gleason 9

I just got my results in the mail. I had a PSA, Ultrasensitive W/O Serial;Venipunture

PSA/Ultrasensative W/O Serial


Results: <0.015 ng/mL (I am hoping this means darn near untectable!!)


it says:

Roche ECLIA Methodology:

According to AUS, the serum PS should decrease and remain undetectable after a RP. The AUA defines biochemical recurrence as an initial value PSA Value of 0.200 ng/mL or greater followed by a subsequent confirmatory psa of 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 milignant disease. Dir. Daniel Towell MD,

Wow..... I am so excited. Maybe I just might have a beer after all or even two! Going to the SeaHawks game tomorrow (we got a suite) for winning a sales contest. Wow... I am just literally shaking I am so happy!! Thanks again! Brian :)

Brian -

Congrats, you are looking good!!

Bobby Mac

Touchdown!! :)

Brian, ED is one of those truly unpredictable things. With you starting at G9, that non-detectable PSA after 7 weeks is an awesome sign. Just make sure you keep getting that PSA checked every 3 months for a while. For today, you're cancer free. And, knowing where you started, that is just awesome!

I guess my only thoughts on the ED front are...play around if you feel like it, and you never know what might happen. And, if it does, even part-way, use it the best you can with our blessing. I always remember what was in the printed follow up paperwork my surgeon passed out:

"Erections return gradually and quality improves month by month. The stimuli for erection during the first year will also be different. Visual and psychogenic stimuli will be less effective and tactile sensation will be fore effective.....For this reason, do not be be afraid to experiment with sexual activity-you can do no harm. If you obtain a partial erection, attempt vaginal penetration. Vaginal stimulation will be the major factor that encourages future erections..."

At least, that is one doctor's opinion. And, it worked for me.

Roche ECLIA Methodology:

According to AUS, the serum PS should decrease and remain undetectable after a RP. The AUA defines biochemical recurrence as an initial value PSA Value of 0.200 ng/mL or greater followed by a subsequent confirmatory psa of 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 milignant disease. Dir. Daniel Towell MD,


I am a bit confused... For some reason, I thought I have been reading the BCR is at 0.02 where as the AUS and Labcorp both state that it's 0.200. And another gest that is 0.200ng/ml This is quite different that what I am assuming is BCR at 0.02.... Can someone please help clarify? My present psa is at 0.014 after 2 years of my RP. I am scheduled to meet with a Dr. Hsi in Poulsbo for his opinion about my case.

ID Date PSA Score location of Test Comments
1 10/12/2016 <0.015 Dr. Porters Office Lab Corp
5 2/15/2017 <0.015 Dr. Porters Office Lab Corp
2 2/2/2018 0.009 Dr. Porters Office Lab Corp
3 4/16/2018 0.008 Dr. Porters Office Lab Corp
4 8/9/2018 0.014 Dr. Porters Office Lab Corp

If BCR is really at 0.2 vs 0.02 I feel a bit better.
Brian

Brian,

A PSA of 0.2 is the sort-of official cutoff for declaring biochemical recurrence but there is a lot of recent evidence that it is way too high for high-risk guys like you (and me).

In particular, there is a study that shows that a high percentage of high-risk men whose PSA rises to 0.03 after RP will see their PSA keep rising to the 0.2 cutoff. When you combine that data (that BCR is almost inevitable at 0.03) with other studies showing that earlier is better in terms of salvage radiation for high-risk patients, it's hard to avoid the conclusion that you want to pull the trigger well before 0.2.

Of course, you're not there yet. But if your PSA keeps wobbling generally upwards for a while you may get there. For now, just stay on top of it. And, this might be a good time to find a RO that you like, if only to have a name in your Rollodex.

I got this reply from a very prestigious doctor, https://www.firstdaytoncyberknife.com/dr-hughes/

I was always under the impression that BCR was 0.02, but according to the other sources it seems to be 0.2 or 0.3 or has he says, 0.4

His comments:
Mr. Tinsley,

Thank you for your interest in First Dayton CyberKnife. Dr. Hughes is indeed an expert in SBRT.
I shared with him your email and this is his response:

“There is no reason to “freak out.” The PSA levels are certainly consistent with no evidence of disease. The sensitivity of the PSA test is not accurate to even 2, let alone 3 decimal places. I would not worry about salvage treatment unless the PSA is in the 0.4 ng/mL range, if ever. CyberKnife is not appropriate but rather IMRT with concurrent androgen deprivation therapy.”

He also recommends that if you continue to have concerns or any returning/increased symptoms to see your trusted urologist as soon as possible. There can be several causes of a slightly variable PSA or urological symptoms.

All the best,


Kathy Corbett, CMM, CMOM
Practice Administrator
(937) 293-2273
2632 Woodman Center Court
Dayton, OH 45420

Your 1st score was <0.015 i.e you became a member of the zero club. All 3 of your most recent scores are still <0.015. The sign< is gone but the scores are still less than your original score. I liked math in high school & college.