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Should PSA lab results have different "normal" ranges listed on the reports?

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Posted 10/3/2018 6:30 PM (GMT 0)
I had my prostate removed 9 years ago. Since then my PSA has been <0.02. Great!
But the report lists the normal range as 0.0 to 4.0. If my PSA suddenly jumped to 0.50 the report would still list the result as Green, "Normal" without highlighting it for my primary care physician.
My normal range should be 0.00 to 0.03. If my psa even jumped to 0.05 I would be planning treatment.

I recall someone here mentioning that his PSA result was 2.6 and his doc said it was normal, nothing to worry about. The guy had to remind the doc that he did not have a prostate and that was, in fact, a terrible post surgical result.

Shouldn't there be some way to automatically adjust the normal range for patients with or without prostates so they do not have to rely upon the PCP remembering their treatment?
A tick mark on the test ordering box would select the maximum normal range. 0.05? or 4.0? It would be so easy to do. And we would not have to rely 100% upon both the patient and the doc remembering treatment.
Posted 10/3/2018 9:57 PM (GMT 0)
There should, but given the medical system and current state of record keeping, it isn't likely to happen.

My health plan doesn't automatically email PSA results. The result can only be forwarded to me by a doctor or nurse under instructions from a doctor or the doctor can tell me in person or over the phone.

Andrew
Posted 10/3/2018 10:30 PM (GMT 0)
Remember these are set up for normal ranges prior to treatment. After treatment the normal ranges are meaningless. Be your own advocate nd understand what is going on and ignore the boilerplate.

So if we follow this request we need new multiple normal ranges. One for surgery, one for radiation, one for recurrance......the list goes on. The more complexity, the greater opportunity for error. Maybe at some future AI breakthrough this might occur, but not now.
Posted 10/3/2018 10:36 PM (GMT 0)
Postscript.......if anyone can start a tech company to attack this it is Worried Guy. Why retire when there is a new challenge to be met!

Actually, this is not limited to us. I am sure many other conditions result in metrics that are out of normal range, but expected. You are probably on to something.
Posted 10/4/2018 12:16 AM (GMT 0)
So-called "normal" range pre-treatment could/should also adjust according to age.
Posted 10/4/2018 12:28 AM (GMT 0)
WG, Yup, its stoopid.

Even LABCORP, which measures their uPSA down to .006, states on the report that 0.00-4.00 is normal range. And they have to know, that nobody with a prostate is taking their uPSA. So whats up with that?
Posted 10/4/2018 12:45 AM (GMT 0)
Pratoman,

If you read further, you will see that the Labcorp report also says:

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.
Posted 10/4/2018 1:38 AM (GMT 0)
It wouldn't matter...folks only like change...if they can find it for the collection plate...ya can't hear paper when it drops
Posted 10/4/2018 2:14 AM (GMT 0)
Frackme I checked and yes, you are correct.
And yet just above that, on the report, it gives a reference range of 0.0-4.0. Makes no sense to me.
Posted 10/4/2018 3:11 PM (GMT 0)
It would be so easy to do!

The lab request sheet my doc uses to order the PSA test has 2 boxes: Diagnostic and Screening
Diagnostic is for 2 digit resolution
Screening is single digit.

Let's make the Diagnostic normal range go up to 0.20
and keep the Screening at 4.0.

If someone is over those values that will flag it for their docs and trigger a discussion. Easy!
Except it would be like moving a mountain.
Posted 10/4/2018 3:45 PM (GMT 0)
or another solution...just keep all paper work out of the nurses or worse the receptionists hands...and maybe even the local Uros...my money...my psa...send results directly to me...frack em all and...it would be ok to let the janitor see it tho..
Posted 10/4/2018 4:05 PM (GMT 0)
I think doctors change $40 per box they click ...
Posted 10/4/2018 4:44 PM (GMT 0)
There are no boxes to check because it is known the doctors wouldn’t bother to check them, thus adding to the confusion.🙂
Posted 10/4/2018 4:48 PM (GMT 0)

InTheShop said...
There should, but given the medical system and current state of record keeping, it isn't likely to happen.

My health plan doesn't automatically email PSA results. The result can only be forwarded to me by a doctor or nurse under instructions from a doctor or the doctor can tell me in person or over the phone.

Andrew


That was my situation for years. A quarterly battle with the uro's front desk. Then everything changed. Now I have access to any of my results thanks to web portals at UMass Medical Center, Dana Farber and the VA. A huge improvement. It's our information. We are the customers. We shouldn't have to fight for it.
Posted 10/4/2018 8:53 PM (GMT 0)

Worried Guy said...

The lab request sheet my doc uses to order the PSA test has 2 boxes: Diagnostic and Screening
Diagnostic is for 2 digit resolution
Screening is single digit.

Let's make the Diagnostic normal range go up to 0.20
and keep the Screening at 4.0.

If someone is over those values that will flag it for their docs and trigger a discussion. Easy!
Except it would be like moving a mountain.

That might not work for guys after RT. My RO orders "Diagnostic" PSA readings but since I still have a prostate, and it hasn't been that long since treatment, my current reading will be well beyond 0.20, but a reading of 0.50 or even 1.0 would be nothing to be concerned about at this point. We still want/need the 2-digit precision, though.

Your point makes sense, but we would need to fine-tune the ranges or allow another check-box for RT patients.

Now, as a recovering consultant, I will warn you. . . "Beware the creeping scope."
Posted 10/5/2018 1:09 AM (GMT 0)
Worried Guy, Like you, I stopped relying on the Siemens Centaur assay because it always produces a low positive reading (0.019 last month) when every other assay I tried was undetectable. I still see the Centaur results once a year because my Endocrinologist has PSA on a standard panel that he runs and uses the Siemens assay.

So I agree with you that there should be standard ranges depending on the type of patient (and not just generic disclaimers like Labcorp and Quest), but there should be warnings that occasionally the PSA test for certain post prostatectomy patients is not accurate and they should also get a confirmation from another brand of assay.

Have you ever gone back to get a test on the Siemens Centaur so see if its still showing a positive reading?
Posted 10/5/2018 1:12 AM (GMT 0)

Bohemond said...

InTheShop said...
There should, but given the medical system and current state of record keeping, it isn't likely to happen.

My health plan doesn't automatically email PSA results. The result can only be forwarded to me by a doctor or nurse under instructions from a doctor or the doctor can tell me in person or over the phone.

Andrew


That was my situation for years. A quarterly battle with the uro's front desk. Then everything changed. Now I have access to any of my results thanks to web portals at UMass Medical Center, Dana Farber and the VA. A huge improvement. It's our information. We are the customers. We shouldn't have to fight for it.

The patient portal at 3 different hospitals that I use are a piece of crap. I get my own results and keep my own files. I have results sent to my GP and he gives them to me. Be your own advocate
Posted 10/5/2018 1:38 AM (GMT 0)
Weightloss,

You are my new hero!!! How do you manage to get tests run on 5 different machines with different protocols and assays???

I was part of a study back in 2010 and 2011 comparing Roche and Siemens. That stopped ~2012. I wouldn't even know where to look to get PSAs done on other machines.


Paxton,
in my business we call it mission creep. ;-)

If we had to choose only one value. for Diagnostic tests I propose we stick with 0.2. If your 0.5 (for example) result is flagged isn't that far better than being ignored?
ideally we would set thresholds for every patient and every treatment. But that won't happen in the foreseeable future.
As docs get busier and face more patients, it is too easy for them to simply scan test results looking for any Red marks or big * asterisks. If anything below 4.0 is unmarked, the poor guy with a biochemical recurrence will miss getting treated early.
Which is better - to erroneously flag a few RT guys or let all RT and Surgery, ADT, Hormone etc. guys have results that are unflagged because they are <4.0? I contend the former is preferable in any case.

Post Edited (Worried Guy) : 10/4/2018 7:41:27 PM (GMT-6)

Posted 10/5/2018 1:52 AM (GMT 0)
Hi WG, I split my days between Philadelphia and Singapore, and have doctors on both sides of the world and a great variety of assays. There is a lab near Philly called Atlantic Diagnostic which uses the Siemens Centaur. I've also tested at Labcorp (Roche Cobas down to < 0.006) and Quest (Beckman Coulter down to < 0.02). To get a test at Labcorp or Quest, you just use one of the testing websites like walkinlab.com. They generate a scrip from a doctor in Florida for an Ultrasensitive PSA test at any Labcorp or Quest (you choose) for about $100.

Your posts many years ago on the problems with the Siemens assay led me to test on several different brands of assays with undetectable results. So thanks!! Over the past year or so, I've noticed two other Healingwell posters who had issues with the Siemens assay.
Posted 10/5/2018 3:32 PM (GMT 0)
Weight loss
New York required a doctor's order to run a blood test - even if you are paying out of pocket.

I few years ago I looked into this when I was having PSA anxiety and didn't want to wait 6 months. I would have had to go to Pennsylvania or Ohio. That is the same for buying an incontinence clamp.
It seems like a pretty neat money making scam for the docs in Florida.

It's strange. NY state allows me to buy a Glock 30 with 50 rounds of ammo and 3 extra magazines but it does not allow me to buy a winkie clamp or order my own blood test even if I am paying full price from my own money.
What the heck?
J
Posted 10/5/2018 4:44 PM (GMT 0)
Paxton
I think it was A.L. Tennyson who said: "Tis better to have PSA results flagged unnecessarily than never to be flagged at all." smile
Jeff
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