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Posted 6/17/2022 2:51 PM (GMT 0)
My GP sent me to a URO when my PSA had jumped over the prior three months. Got a 12 core BX. Four were positive (highest percentage was 26%) and two suspicious all on the right. All I knew about prostate cancer then was I wanted it out and opted for the Davinci, primarily because as I understood it should the cancer return it's easier to do radiation to address it than having radiation first. No oncologist. Nothing. I was GL7 (4+3) pre and GL7 (3+4) post. EPE, focal on the right and PSM unifocal on the right. All post PSA's are "virtually undetectable."

Then I found this site just last month and question if I should have or should now question the Uro about the EPE and PSM or consult with an Oncologist? Or are they just not worth worrying about five years post BX?

I feel fine, exercise four or five days a week, weight is good. I don't sleep well, have big time incontinence, sex drive and sex ability is a thing of the past.

Thanks.
Posted 6/17/2022 3:17 PM (GMT 0)
Well, Tico, glad you've found us. Your story is not uncommon, unfortunately. My first question: what is "virtually undetectable". Do you have a "<" in front of your PSA readings? If so, that IS undetectable. If you have an actual number there, what is it? How long has it been there, give or take a little?

If you have persistent and stable, but low PSA, it means there is some active prostate tissue left behind. As long as your PSA is stable over time, it is likely not a lot to worry about, IMO.
Posted 6/17/2022 3:37 PM (GMT 0)
Halbert, the URO always tells me "virtually undetectable" but the lab shows <.1.
Posted 6/17/2022 3:50 PM (GMT 0)
Welcome Tico. My pathology was very similar to yours. My uro warned me that the cancer could come back due to the G4 and EPE. He was correct, as PSA started rising 5 years after surgery.
Just make sure you get your PSAs done and make sure it is the post prostatectomy PSA (high precision) one, NOT the regular screening PSA. My new GP did not even know what the high-precision PSA was (different lab code).
Posted 6/17/2022 3:51 PM (GMT 0)
Hi Tico, and Welcome to the Forum! With your adverse findings of EPE and PSM, you may want to monitor your PSA with an ultrasensitive test. The test your doc is using has a lower limit of 0.1 (where <0.1 is "undetectable") and is the PSA test designed for men with prostates. A 2- or 3-decimal (ultrasensitive) test is designed for post-RP men and will give you (1) a better idea of what your actual PSA value is and (2) it will allow you to track any rise with plenty of lead time.

If, with an ultrasensitive test, your PSA approaches 0.1, you might seek out a radiation oncologist--you could get a plan in place which should give you some peace of mind if your PSA then continues to rise. However, if a more sensitive test shows your PSA is much lower (say 0.03 or below), you would have even more peace of mind and could rest easy for now. In a nutshell, a result of <0.1 tells you nothing about how close you are to 0.1. That test may be fine for G6 (3+3) men who come through surgery with flying colors (pT2 with negative margins), but it's not ideal for men with adverse findings at surgery, especially those who take an active interest in their status.

Djin
Posted 6/17/2022 3:52 PM (GMT 0)
Tico, our numbers and procedures are quite similar. I know lots more about all of this after my decisions were made than I did when I made them, much thanks to this site.

Regarding the incontinence, I waited a year, doing Kegels, working with a PT, and finally went ahead and had the artificial urinary sphincter installed. Like you, I am also very active, running, swimming, etc. and just didn’t want to deal with the pads any more.
Posted 6/17/2022 3:56 PM (GMT 0)
Tico, I would not beat yourself up over the decision that you made regarding treatment. Instead, focus on the things that you can do to heal the incontinence and the ED and move forward. That is energy well spent. And welcome to HW.
Michael
Posted 6/17/2022 5:28 PM (GMT 0)
Djin, et.al., In a word, Thanks. The first time I heard the words "virtually undetectable", several weeks after RALP, I thought it meant something like .0000000000001, so no worries. Then when finally getting around to the lab reports I saw they were all <.1. Which left a lot for discussion and concern. I will inquire about an ultra sensitive test, with two or three digits beyond the decimal. I go back in November for lab and consult. I got tired of going back twice a year so just this year changed it to annually. Ramon, oh, great! I'm going back for my five year post surgery consult in November. 60Michael and Vince, I did Kegels pre and post surgery and they did no good. I wear "absorbent materials" provided by the VA at no cost to me - otherwise I'd be broker than I am now. As to the AUS, I've heard many more good stories about it than bad, but it only takes one to scare me away. Ditto to the sling.
Posted 6/17/2022 6:58 PM (GMT 0)
Tico, correct. "Undetectable" simply means below that test's lower limit of detection. So, for example, Quest's ultrasensitive test can detect down to 0.02, so it's undetectable appears as <0.02 on the lab report. Labcorp's ultrasensitive goes down to 0.006, which means it's undetectable is <0.006, and so on.

Djin
Posted 6/17/2022 10:28 PM (GMT 0)
Sorry, Tico. Didn't mean to freak you out about the 5-year anniversary. I just wanted to emphasize that we should never consider this demon disease as "cured". Just keep doing due diligence and followups and you should have a long life.
Posted 6/18/2022 3:59 PM (GMT 0)
It’s always been my understanding (possibly incorrectly) that, clinically speaking, the definition of “detectable” is .1

Anything under .1 is characterized as “undetectable”.

Does anyone know whether or not that definition has been changed?
Posted 6/18/2022 5:12 PM (GMT 0)

island time said...
It’s always been my understanding (possibly incorrectly) that, clinically speaking, the definition of “detectable” is .1

Anything under .1 is characterized as “undetectable”.

Does anyone know whether or not that definition has been changed?

Island time, that is true in the commonly used sense of the word, since the PSA test used was and still generally is the one with a <0.1 undetectable. And if you use an ultrasensitive test and your PSA is, say, 0.022, you can still call yourself "undetectable" using that standard, even though your PSA was, in fact, detected (and therefore not undetectable) by that test. In my case, aside from my first post-op PSA which came back <0.1, my ultrasensitive tests have always been low but never <0.006 (Labcorp's "undetectable"); however, speaking generally, I would, as you say, describe all my results as "undetectable" since they were all below 0.1.

A post-RP PSA of ≥ 0.1 is I believe, also the definition of "persistent PSA" (although if you are high risk with significant post-op adverse findings, a post-RP uPSA of, say, 0.90 is probably "as good as." That is why men in that category may really want to know just how far below 0.1 they are. A post-RP nadir below 0.03 is good; below 0.01 even better. A <0.1 result doesn't provide this information either.

Djin

Post Edited (DjinTonic) : 6/18/2022 11:27:25 AM (GMT-6)

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