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uPSA result year 5

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Posted 11/14/2022 11:49 AM (GMT 0)
Good morning, haven't posted for a while.

My dad had surgery almost 5 years ago. He has been on a 3 month PSA testing schedule for 4 years and every 6 months during last year, always undetectable (<0.008).

Last PSA came back 0.009, very low but still detectable for the first time in years. He also got Covid last month and next appointment with his uro is in 4 weeks.

Should he consider going back to PSA testing every 3 months? Is it possible that we are heading to recurrence with such small PSA elevations after this long?

Thanks in advance

Mary

-----------------------------------

08/2017 PSA 12.4, DRE+
Biopsy 10/12+, 3+3 to 4+4 (5%-70%)
Surgery 02/15/2018
Post-op. path.: 4+3 (22mm) and 3+3, T2c, margins-, EPE-, vessels-, 10/10 LN-, PNI+

PSA after prostatectomy
Undetectable <0.008 through 05/22
11/22 0.009
Posted 11/14/2022 1:25 PM (GMT 0)
Hi, My boyfriend became detectable about 7 years after surgery. It can happen. It's time to track it. You've got a long runway, so I would not be concerned at the moment. When PSA approaches .2, that is when you would start to think of possibly salvage radiation. My boyfriend had SRT at .13. It's a shock, considering you think it is behind you. It could be years before you get to SRT. It could not happen at all. PSA can bounce around in the low ranges. Hope all works out well.
Posted 11/14/2022 2:00 PM (GMT 0)
Thank you. My dad is young (3 days shy of 62) and this is something I would never want to experience again. Not the best birthday gift for him.

I hope your boyfriend is doing well.
Posted 11/14/2022 4:51 PM (GMT 0)
Hi Mary, There are non-prostatic tissues--such as the urethra and Cowper's glands--that normally produce minute amounts of PSA, and ultrasensitive tests can sometimes pick this contribution up, and it's thought that contribution can vary a bit.

You dad's prior readings of <0.008 could mean that his PSA was, say, 0.007 or 0.003 or 0.006, so 0.008 is barely detectable for that ultrasensitive test and nothing at all to worry about. In other words, a test result of <0.008 doesn't mean zero. And strange as it may seem, some PSA test do not give zero when run on a test solution that contains no PSA, but rather show some small value!

In addition, when put to very strict testing, these ultrasensitive assays won't always give the exact same value when they are repeatedly run on the same sample. For example, Labcorp's uPSA test (for which the undetectable is <0.006), had a S.D. (standard deviation) of ±0.001 when a sample of known PSA concentration was tested in ideal conditions 20 times in a row with Labcorp's assay. Statistically, a range of ±2 SD covers about 98% of test all results. The bottom line is that one's uPSA with Labcorp's test can vary ±0.002 if the test is run again on the same blood draw. I'm sure something similar holds for any commercial ultrasentitive PSA test.

So one's physiological PSA fluctuation, equipment calibration, and assay limits can all contribute to fluctuating results. There is inherent uncertainty in the right-most digit of any lab test. Don't be surprised if your Dad's next result drops back to <0.008. Long story short: IMO your dad can stay on a 6-month schedule. smile

Djin
Posted 11/14/2022 6:26 PM (GMT 0)
Mary,

I'm with you and your Dad. It's been just over 4 1/2 years for me as well and all PSA's since RALP have been virtually undetectable. I'm not going to waste my or my URO/Surgeon's time continuing as I have as I'm getting PSA's from my PCP and the VA as well. Should one of them show a rise in PSA levels at some point I may go back to the URO but right now it's a waste of time.
Posted 11/14/2022 9:10 PM (GMT 0)
Hi Mary, yes, not the best birthday gift. The anxiety is unavoidable. Try to put it in the back of your mind, and for now, track PSA. You'll see a trend... if there is one. No reason to go back to 3 months intervals at the moment.

My boyfriend is doing well. SRT was a marathon, but got through it. PSA still bounces in the low ranges, but is stable, so we are not worry about it. He just turned 75. He originally had surgery at 64. This is the gift that keeps on giving.

Good luck!
Posted 11/15/2022 12:04 PM (GMT 0)
Djin, Tico, thank you. I suppose the only thing to do is to wait and watch.
My dad's attitude is positive and this is what matters most to me.

Do you think uPSA remains the best choice for patients after radical prostatectomy?
Considering that readings can vary and we can't do much until PSA is 0.1 or above, how useful can be to go that low?

Of course I don't want to ignore reality if recurrence is where we are heading, but the emotional side is also to consider...

Many thanks,

M.
Posted 11/15/2022 2:46 PM (GMT 0)
Mary,
Your Dad and I are on the same path.

I have no plans to worry about any rise in my PSA given the last 4 1/2 years have shown "nothing".

When, or if, I do get a rise I'm still not going to worry about it until it reaches .2 and then I'll start my surveillance to see if it continues to rise beyond that number (which is considered a biochemical recurrence - BCR) at which point I may address it.

I may die with it but don't figure I'll die because of it.

Good luck on you and your father's journey.
Posted 11/15/2022 3:15 PM (GMT 0)
Thank you Tico for the insight and good luck on yours as well! smile
Posted 4/20/2023 12:57 PM (GMT 0)
Hello,

it's been 5 years since my dad prostatectomy and I'm very happy to share his most recent PSA result <0.008. He's undetectable again after a small increase 6 months ago. Still wondering if Covid played a role in it.

Being a high-risk patient, this feels like a major milestone for him and I can't wait to be together and celebrate.

Thanks again for the support and the kind words when I needed them.

Mary
-----------------------------------

08/2017 PSA 12.4, DRE+
Biopsy 10/12+, 3+3 to 4+4 (5%-70%)
Surgery 02/15/2018
Post-op. path.: 4+3 (22mm) and 3+3, T2c, margins-, EPE-, vessels-, 10/10 LN-, PNI+

PSA after prostatectomy
Undetectable <0.008 through 05/22
11/22 0.009
04/23 <0.008
Posted 4/20/2023 1:26 PM (GMT 0)
That is great to hear, Mary.
Michael
Posted 4/20/2023 1:44 PM (GMT 0)
Congratulations!
Posted 4/21/2023 3:56 PM (GMT 0)
Terrific news. And yep, 5 years is a big milestone. Congratulations
Posted 4/21/2023 10:30 PM (GMT 0)
My urologist and I had a discussion years ago. He says he has had treatment issues with patients of an engineering/mathematical background. He said people with this type of background tend to apply that outlook to the biological system of the human body.Rather than focusing on one particular (incredibly small) number as an engineer might, you have to look at the situation as a whole. Both the test equipment and (especially) the human body have a tremendous number of variables, some known and some unknown.PSA is not an either/or measurement, it is a machine measurement of a variable biological antigen with all those variables.
Things look good for now. So test at 6 months and watch for a trend.
Posted 4/21/2023 11:44 PM (GMT 0)
"When, or if, I do get a rise I'm still not going to worry about it until it reaches .2 and then I'll start my surveillance to see if it continues to rise beyond that number (which is considered a biochemical recurrence - BCR) at which point I may address it."

i suggest you research when to worry. .2 is late in the game
Posted 11/27/2023 2:02 PM (GMT 0)
Good morning everyone,

I'm back on HW to give an update on my dad's situation.
After becoming detectable in 2022 with a very low PSA level, he jumped back to undetectable in April 2023.
2 more tests (May and November 2023) resulted in very low, but slightly rising detectable PSA levels, the last one at 0.010. Details are in signature.

My dad is almost 6 years out of surgery and, according to his oncologist here in Italy, the standard of care for organ-confined patients who are "undetectable" after 5 years is only to have PSA tests twice a year. The doctor told to my dad that, except for biannual PSA tests, he can consider himself "free" and he won't need to come back unless his PSA ever rises to 0.1.

I'm aware that his current PSA level is still quite low, but I'm worried about the "0.1" thing. I've recently read several papers that consider 0.03 as a good prognostic level for BCR. 0.1 is more than 3 times that value.

What is your suggestion here? My dad fully trusts his doctor, but this time I feel like we should be more prepared and proactive than the first time. In your opinion, what would an adequate threshold be to start discussing the next steps? I love my dad and the last thing I want is to put pressure on him... but I also don't want to make any missteps.

Many thanks for the support!

Mary
---------------------------------------------------------
08/2017 PSA 12.4, DRE+
Biopsy 10/12+, 3+3 to 4+4 (5%-70%)
Surgery 02/15/2018
Post-op. path.: 4+3 (22mm) and 3+3, T2c, margins-, EPE-, vessels-, 10/10 LN-, PNI+

PSA after prostatectomy
Undetectable <0.008 through 05/22
11/22 0.009
04/23 <0.008
05/23 0.008
11/23 (5y 9m) 0.010
Posted 11/27/2023 4:08 PM (GMT 0)
Mary, I think everyone is different, but I tend to agree with you about the .1. I pulled the trigger on SRT at .08, because I was testing every 3 months and saw a slow steady rise. Others would prefer to wait.

Seems to me that just as important, if not more important, as the number, is the trend. If you get 3-4 small rises in a row, even if the number is .06 or something like that, I would want to at least start preparing to see a Radiation Oncologist so that if it continues to rise beyond that, you can pull the trigger quickly
Posted Yesterday 10:07 AM (GMT 0)
Dear Pratoman,

many thanks. I agree with you that sooner is better than later. Based on my experience, the EU approach is slightly less "aggressive" than the US one with BCR. Several people I talked to pulled the trigger somewhere between 0.1 - 0.2. Some of them are ok, some others are not.
I am not a doctor and I will never know what's better for my dad from a medical point of view, but your story and some others I read on this forum gave me perspective. Thank you for sharing yours. Better informed than sorry.

I will probably start talking to my dad when (or maybe if) he hits 0.05/0.06, to consider talking to a RO, hopefully not earlier than a few years.

Just one last thing... when everything started 6 years ago I was afraid that my dad wouldn't be able to attend my wedding. The next September he will walk me down the aisle and he is happier than ever, helping me with the preparations and giving advice on the reception menu. I feel this is a huge milestone for him, regardless of what the future holds.
Posted Yesterday 10:28 AM (GMT 0)
Hi Mary--great to hear from you. A 6-yr, post-RP PSA of 0.010 is very good and IMO bodes well.

I am 6+ year post RP and my last two readings were 0.068 and then 0.065 (my nadir was 0.007). So I've been slowly climbing. My uro and I have planned that I'd consult with a R.O. if and when I reach 0.1. My Uro said my PSA is still low and could plateau--which I may be doing, but it's too early to tell. When my PSA started to rise (slowly) we went from 6-month checks back to 3-months.

I neglected to answer a question you asked previously. Yes, I think it's worthwhile to keep monitoring with the 3-decimal uPSA test, not so much to track the fluctuations of the third decimal place that are bound to happen, but rather to round to two decimal places and be more confident in the resulting number than if you were to do a lab's 2-decimal PSA test.This is because there is uncertainty in the right-most digit of any lab test. Also, at low values, the actual number is less important than the trend and rate of climb if the PSA is rising.

In general, it's best to monitor PSA with the same test done at the same lab.

All the best to your family for the holidays!

Djin
Posted Today 5:45 PM (GMT 0)
Dear Djin,

many thanks for your clear explanation. The next three-digit test will be in May at the same lab.
I spoke to my dad in person today and he told me that his Uro suggested to test only once a year. I'd feel more confident with a 6-month testing and both my dad and my brother (who is a doctor) agree with me.
Also, my brother spoke with a colleague RO at the hospital where he works (one of the best in Milan and Italy) and it looks like the process could move pretty fast in case of need. At the moment is just waiting but the idea of having things in place makes me feel better.

I really hope your PSA remains stable. Hopefully we will talk in a few months with wonderful news from both sides!

Happy holidays to you!

Mary
Posted Today 6:46 PM (GMT 0)
Mary, if getting tested every six months is more comfortable for your family then by all means please insist on it. As you know, it's only a blood draw and simple test so go for your peace of mind.

Jim
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