less than .1 VS less than .01?

i'm in my ninth year of remission. my PSA is .1, which is the lowest reading from LabCorp.

I echo what others have said.

Two consecutive uPSA reading of 0.03 or higher could mean BCR -but that’s for folks after Surgery.

Since you had BT , that theory ( albeit controversial) is not valid for you.

My 2 cents is that you are good to go with a reading of <0.1 !!!

I had surgery in 2/2009 and my ultra sensitive PSA was <.01 for 8 years. in 2018 it came back as .03. My urologist is recommending that I see an oncologist because he believes it may be BCR.

you are making the classic case for the dangers of ultra sensitive testing. if you are under .10, feel fortunate.
who said .003 is evidence of BCR? that doesn't sound correct or sensible to what I have learned the past 10 years.

Thanks for all the supportive commentary and valuable information. I looked closely at the LabCorp info and read "Roche ECLIA methodology". Quick blackle seemed to indicate that test was done to display PSA and free PSA outcomes but not much more. Was hoping it would reveal explanatory info on ultra sensitive or the lack of readings.

Apparently LabCorp is yet one more corporation that eats up smaller corporations.

As others have said...the 0.03 'rule' is for surgery patients, not radiation patients. You still have a prostate, and it can still, in it's cooked state, put out some PSA. Keep getting the 'standard' test and fuggetaboutit

Mumbo, I'm not a repository of links to research--but here's my understanding, for what it's worth:

Not all that many years ago (15-20), there was PSA. It had a low detection limit of 0.1. So, for all cases, "cure" was defined as <0.1. Also, 15-20 years ago, there was surgery--and surgery--and surgery.

As the PSA test has gotten better (or at least lower detection limits), the definitions of what to look for have also gotten refined. The problem is noise. At the very low levels that we are now seeing....things like <0.006....the scatter due to 'noise' can be significant. Again, the only way anyone can achieve those kinds of levels is if there is NO active prostate tissue in the body, at all. And surgery is the only way to make that happen.

Now, for radiation patients: With radiation, the PSA will go down over time. Sometimes a long time--a year or more. Because the gland is still there, the healthy remaining tissue is generating PSA. So, it's rare to go non-detectable. Now, with ADT in the mix, which deactivates--but does not kill--the remaining tissue, the PSA can get to the non-detect levels, sometimes.

I'm not a radiation patient, so I've never had this conversation with a doctor. What I surmise is that the important thing for the radiation patient is to keep track and note the trend downwards, and see where it settles--this is called nadir. It will be a positive value, but not zero--and it will depend on the patient where it lands. To determine recurrence, then, one has to define a value for a cancer-caused increase--whatever it might be.

In both cases, the perspective is to figure out two things: 1. Is what we are seeing real and due to cancer? and 2. At what point of increase do we have the best chance at cure without creating more trouble? And that, fundamentally, where those numbers come from.

Obviously there are different thoughts on the post-surgery PSA test. I just received my first test today, 6 weeks out, and it said <0.1. I guess my doc is not so interested in the ultra-sensitive test. I see him tomorrow, so it will be a good question to ask.

Thanks for this thread.

Post Edited (Depov) : 2/26/2019 9:44:53 AM (GMT-7)

Paul, I have my doubts, given the inherent instability of the Ultrasensitive test, whether it is particularly useful for surgery patients. Currently, where I get mine, they go to <0.006. Next, I'm sure, someone will come up with a way to get to <0.002, and after that, <0.0005 or something. Where does it stop? And, more importantly, what does it really mean?

I echo PDL17’s comment that “The fact your PSA was less than .01 for a radiation patient is extraordinary,” and then also InTheShop’s comment that “the digits below .1 aren't going to be helpful to you,” and ultimately halbert’s suggestion “Keep getting the 'standard' test and fuggetaboutit.”

Most of the other comments here should be ignored as they have inappropriately mixed PSA monitoring guidance into a one-size-fits-all approach when one-size-DOES NOT-fit-all.

First and foremost, and obvious to most, is that PSA monitoring for primary surgery patients and primary radiation patients is completely different…and don’t belong in the same conversation.

Second, there are significant differences between external beam and brachytherapy guidance for post-treatment PSA monitoring…their results (and the patterns of PSA decline & bounce) are typically different. PSA nadirs following EBRT to undetectable levels are uncommon because this technique does not fully ablate normal prostate tissue; PSA nadir to 0.5ng/mL predicts low rates of BCR. On the other hand, 90% of BT patients reach a nadir of less than 0.5 ng/mL, with a median value of 0.10 ng/mL when measured with ultrasensitive PSA testing (for study purposes). SBRT typical nadir is between EBRT and BT; closer to BT.

Regardless of the specific RT technique, the (“Phoenix”) definition of BCR remains the same: nadir + 2ng/mL…which is more than an order of magnitude greater than the “standard” PSA test lower limit of 0.1ng/mL. The ultrasensitive PSA test for radiation patients is clearly unnecessary.



Off-topic: There needs to be a specific REASON to justify prescribing the ultrasensitive PSA monitoring test to primary surgical patients…most commonly a good reason is unfavorable surgical pathology. Unless there is a good reason for a surgical patient to have the ultrasonic PSA monitoring test, then the standard test is the right choice.

Depov said...
Obviously there are different thoughts on the post-surgery PSA test. I just received my first test today, 6 weeks out, and it said <0.1. I guess my doc is not so interested in the ultra-sensitive test. I see him tomorrow, so it will be a good question to ask.

Thanks for this thread.

Tell doc you want a uPSA. I use Primco lab all there PSA tests are uPSA. I know labcorp only goes down to <.1

Since you are referring to me browntrout...you have not offended me one bit...I will stand by the < 0.01 as someone's mistake with numbers...at this point...it really doesn't matter and probably never did who.. I was actually hoping beyond hope that someone would contradict me with a reasonable explanation as to how the < 0.01 happened...I love criticism (but then again there are no absolutes thankfully)...its a great way to learn...I am actually still hoping for that reasonable...and again no BS explanation...please some one do not create a straw man...named surgery...ya gots to admit the original thread post had a multitude of errors with decimals... and other misinformation...such is the curse of forums such as these...I try to correct them...but it is so commonplace here...that well...one does what one does...caveat emptor...I also try to redefine support...there is no fine line between support and enabling...there is a chasm/abyss/infinitude...I want to say endless summer..so did...but of course that's silly...but breaks the ice...wait that would be an endless...er never mind