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Standard vs UltraSensitive PSA 3 yrs out from triple play

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Posted 7/5/2021 6:57 PM (GMT 0)
Hey guys.
Well it's time for my regular PSA test... I had to switch back to an older doctor who accidentally gave me a standard PSA test vs UltraSensitive... im not sure uf I should make a big deal out of it... are any of you guys just getting standard PSA vs UltraSensitive 3 yrs out from triple play? (Surgery, hormone and radiation)??

Thanks
Zzarth
Posted 7/5/2021 7:12 PM (GMT 0)
Usually the term “triple play” is used for a combination of brachytherapy, external beam radiation and ADT. For those men, like myself, the standard test is used.

I think what you had was surgery, then SRT and ADT when the surgery failed. Is that correct? For surgery guys the sensitive tests are preferred as I understand, but after SRT and ADT, I don’t know whether the sensitive continues or one can go to the standard test, or whether it matters.
Posted 7/5/2021 7:48 PM (GMT 0)
Hi Zzarth. I think it all depends on what your PSA is. In your linked spreadsheet, I see a <0.006 reading in '20. Is that your latest? Are you in the US? I ask because Abbott is the the only commercial lab I know here that tests down to 0.006.

If that is your number, then yes, you want the same sensitivity test (or at least another uPSA). If you get the standard PSA test for men with prostates and your result is <0.1 you won't be able to tell if your PSA has risen or not (only that it hasn't risen to 0.1).

But to JFN's point, for any guy whose PSA is even a little above >1.0, the extra information would be of no help. It would be like having a digital speedometer that displays 61.132 mph.

Djin
Posted 7/5/2021 8:21 PM (GMT 0)
Thanks guys --- I guess triple play isn't the right term... yes, I had failed surgery followed by Lupron shots and 70.5Gy of radiation... so yes, I guess I need uPSA ... what a pain... I bet the doctor is going to charge me $$ for a 2nd test...

Oh well.. thanks guys!

Zzarth
Posted 7/5/2021 8:23 PM (GMT 0)
Ultrasensitive, if you become detectable, gives advance warning and you can then start looking around for a medical oncologist.

Until you get over 0.2 they generally sort of look at you, pat you on the back, and say see you in 3 months.

With the early warning, you can spend time deciding who you will trust with the next phase of treatments.
Posted 7/5/2021 9:34 PM (GMT 0)
It is really up to you. After surgery and follow up radiation, there is little benefit to knowing too much about PSA since nothing will be done until it gets to the higher values as Stephen noted. Do you really want to know how it gets to >0.10 until such time it does, if it is going to ever happen. The same logic applies to getting testing every three months forever just to have lots of tests and points to fret about. There seems to be two camps on this and no obvious right answer so back to you it goes. You don’t “need” anything at this point other reasonable monitoring for a obvious recurrence if it ever occurs in my humble opinion as one of those folks.
Posted 7/5/2021 9:46 PM (GMT 0)
Zarth,
I've had failed RP and RT and I'm now on lifetime ADT. My MO originally had me on a 0.02 test, which suddenly changed to 0.01 cutoff tests. For where I'm at on my path, a 0.1 test would be okay with me. I'm mostly interested in seeing the "<" sign.
Posted 7/5/2021 10:21 PM (GMT 0)
Hi Zzarth, as you know we had the same experience, same surgeon. I went to MSK for SRT + HT, and they test down to <.05. I asked my RO about it, he basically said, we wouldn't do anything until it got beyond .05 anyway, so they feel .05 is enough of a threshold. I doubt anything would be done until it got above .1 either, so its probably ok, in theory. But i think its also up to the individual. I know sometimes i wonder whats going on below .05 as you might wonder about the .1. But as Stephen said, i think they would at least wait until it got to .2. And even then, you might decide to wait.
Maybe stick with the standard and if it shows detectable ever, which hopeully it wont, then switch to the ultrasensitive test.
Posted 7/5/2021 10:21 PM (GMT 0)
Hi Zzarth, as you know we had the same experience, same surgeon. I went to MSK for SRT + HT, and they test down to <.05. I asked my RO about it, he basically said, we wouldn't do anything until it got beyond .05 anyway, so they feel .05 is enough of a threshold. I doubt anything would be done until it got above .1 either, so its probably ok, in theory. But i think its also up to the individual. I know sometimes i wonder whats going on below .05 as you might wonder about the .1. But as Stephen said, i think they would at least wait until it got to .2. And even then, you might decide to wait.
Maybe stick with the standard and if it shows detectable ever, which hopeully it wont, then switch to the ultrasensitive test.
Posted 7/8/2021 3:51 PM (GMT 0)
Hey Guys - thanks for all the support. It seems that my doctor ran both tests when I got my blood tested last week, so I got the good news today!

<0.01 ng/mL

Performed By: ARUP Laboratories

Woot woot!

How often are you guys getting your uPSA's checked? ... the Anxiety is rough!

Zzarth

Post Edited (Zzarth) : 7/8/2021 10:04:14 AM (GMT-6)

Posted 7/8/2021 4:12 PM (GMT 0)

In answer to your question posted above, my oncologist has me visit the lab monthly.

Each case is different, and such frequent testing certainly isn't needed for every case.

My doctor is watching various blood components, in my case --- liver levels, cholesterol, white & red blood counts, iron levels, PSA --- and making sure testosterone stays suppressed.

I see my oncologist each month, so visiting the lab is part of the routine.

I visit the lab first, then run some errands or grab some lunch, then see my oncologist a couple of hours later. By then, all lab results have been processed, and we discuss results in person.

I benefit greatly from the context, insight, and advice he provides. All lab results are electronically shared with Mayo Clinic, as well.

NOW on to your update!

Wow! Now there's some BANNER HEADLINE news that you just shared, Zzarth!

You probably heard me cheering from across the miles!

Best news of the day, I say!

Weekend is around the corner ---- time to do some celebratin' !

Turn up some MARTHA & THE VANDELLLAS or VAN HALEN and crank up the volume on DANCIN' IN THE STREETS!

Thankful to read your GREAT NEWS today!
CYCLONE ~~~ # Iowa State University
Posted 7/8/2021 4:50 PM (GMT 0)
Excellent! Keep studying for your PSAT(est)!

I was getting checked every 6 months (after 3 years of 3-month testing). However, after a recent jump, we tested again at 3 months and my PSA came most of the way back down. My next test is next week, and if it drops again, I may go back to 6 months.

Djin
Posted 7/8/2021 5:06 PM (GMT 0)
Every 3 months for a lot of guys, longer intervals for others.

I have my blood draws scheduled early in the day and result is posted in about 2 hours on my patient portal. This helps to reduce anxiety for me.

Nice result for you!
Posted 7/8/2021 5:22 PM (GMT 0)
Great news ZZarth.

I get checked every 6 months
Posted 7/8/2021 5:52 PM (GMT 0)
every three months or so……
Posted 7/9/2021 1:32 AM (GMT 0)
Greetings folks! I am also using .05 as threshold and inquired with docs as to why they wouldn’t test at more granular levels if that would identify a trend earlier. I am in the camp of folks that would prefer to see the data in advance. It proved useful in my run up to SRT after surgery where I had the uPSA’s done through a separate outfit from my doc and, as a result, I saw the trend and knew where I was headed before he did. I found value in this and it actually reduced anxiety for me but I totally understand how it could do the opposite for others etc.
Posted 7/9/2021 2:33 AM (GMT 0)
AJ - The question is what are you going to do now, after RALP and SRT? It is pretty clear that the high sensitivity testing is helpful for post surgery patients but once you have done primary surgery and adjuvant/secondary treatment like Zzarth and many of us have, the small numbers are not that important in my opinion.
Posted 7/9/2021 4:36 AM (GMT 0)
Understood Mumbo. I guess I am just a guy that likes data and wonders why I would want to have less when I could just as easily have more, regardless of the significance of the action it would or would not prompt. I am analytic by nature and perhaps this is just a bias. Not suggesting it is the right approach for anyone else and can understand why others would not bother. Having said all of that, I am following my docs protocol and getting their 6 month readings at the .05 threshold until I decide otherwise. So be it for now.
Posted 7/9/2021 10:01 PM (GMT 0)
I am a retired engineer and like numbers as much as the next guy. I would never suggest that anyone change what they are doing if it makes sense to them. After surgery and radiation, things become more binary, I have a problem or I don’t. Just went to 6 month testing of <0.10 this year and I am very content. Seems to be the right thing to do and I do not miss the 3 month reminder about my PCa. As my Dad said, I am cured until the doctors tell me I am not so I am trying to take his attitude towards recurrence and move on from the anxiety days of my diagnosis and treatments. Different strokes for different folks as they say.
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