uPSA now 0.013 after undetectable for 5 years

Hello everyone,

It's been quite some time since my last post here, and I hope you are all doing well.

I wanted to update you on my recent ultrasensitive PSA test results. The test revealed a result of 0.013, and my doctor assured me that this falls within the acceptable/normal range for the post-treatment phase. However, considering my medical history, it has left me feeling quite anxious.

Just to recap, back in 2016, my PSA levels were alarmingly high, around 18. I underwent surgery promptly, which initially brought my PSA levels down to <0.008. Unfortunately, after six months, it began to rise again, leading me to undergo hormone therapy and radiation. Fortunately, my PSA dropped to undetectable levels in December 2017, and it has remained undetectable ever since, with my last test in October 2022.

Now, with this recent result of 0.013, I find myself in a state of panic, worried about the possibility of cancer recurrence. If anyone on this forum has experienced a similar situation or possesses knowledge in this area, I would greatly appreciate any words of wisdom or insights you can offer.

In the past, all my previous uPSA tests were conducted using the Roche PSA electrochemiluminescent immunoassay. However, this time the 0.013 test was done using the BECKMAN-COULTER ACCESS CHEMILUMINESCENT IMMUNOASSAY USING AN UNICELL DXI PLATFORM.

Could this difference in testing methods account for the variation in results?

Thank you all for your support.

Best regards,
Zzarth

Thanks Michael -- I'm so worried I couldn't sleep last night

Zzarth - 0.013 is virtually nothing and PSA should not even be reported to three decimal places in my opinion. Technical precision arguments aside, what do you do with that information now? Nothing but worry about nothing (0.013 = nothing).

I had surgery followed by adjuvant radiation and made the decision to stay with <0.10 sensitivity testing. Why, because I have no practical options below 0.10 so no point worrying about things that I can't control or do anything about. If the magic number of >0.10 shows up some day, my tertiary plan kicks into gear based on whatever technology exists at the time. Knowing that I will have to wait until the PSA is higher for reliable scans and possible focal treatment, 0.10 is plenty of warning for next steps. Who knows, I could be older and have different considerations at that time.

Your situation is similar to mine, you took your best shots, now it is the cancer's turn to make the next move if and when it decides to. Best we can do is eat right, keep weight down, and stay vigilant after all the others things that can shorten our life span.

Keep in mind, I think this way because I had both surgery and radiation. After surgery alone, monitoring the small numbers may make sense for secondary treatment planing at an early stage.

Zzarth,

First off, 0.013 is extremely small. I truly believe the third decimal place is mostly noise, and unreliable for qualitative purposes. But it is GREAT for making people anxious and sleep-deprived.

I am in the same boat. Ten years ago I had robotic surgery and pathology showed a very small positive margin. So two years later my PSA hit the 0.2 ng/ml (Quest Labs) threshold. So I had IMRT/IGRT radiotherapy and my PSA was undetectable (<0.02 ng/ml). Two years ago my PSA became detectable at 0.02 (lost the less-than sign). So for two years, I have been sitting at 0.02. My oncology urologist said don't worry, it might never increase or if it does it will probably increase very slowly. He laughingly said that I will probably die of old age before prostate cancer can do me in.

Here is a bit of wisdom, "Don't worry about anything you don't have any control over".

You’re getting the general idea. I would probably just stay on the same testing interval at the same lab as before, 6 mos or 12 mos? No need to obtain more numbers to worry about at this point just for the heck of it.

The PSA = 0.20 BCR criteria does not really mean much after surgery and radiation. The key will be at what PSA a PSMA scan or equal will have reasonable chance of locating a prostate cancer source in your body that could be addressed. Could be 0.50 before a PSMA scan would show much. There could be better tracers and PET equipment as well in future years.

The >0.20 criteria was typically used after surgery to define a biochemical recurrence (BCR) and that salvage radiation should begin. Once you have had radiation after surgery, you don’t get to do salvage radiation again (too much radiation) if your PSA rises to 0.20 again thus my comment.

The effort now becomes “can I find the source of the cancer recurrence so it can be targeted”. PSA needs to be high enough for a scan to show anything. In the past, it seemed that hormone therapy would be initiated at some PSA which knocks the PSA down which interferes with the ability of a scan to find something so you are not sure what is going on. However, the newer PSMA/PET scans can detect prostate cancer recurrence at much lower PSA levels so it can be prudent to let the PSA rise so the recurrence can be identified and a plan developed.

Basically, if surgery and radiation did not solve the problem, you are in it for the long haul but you are not there yet. No hurry on oncology as they will just tell you to wait. So you sit back and wait, get your PSA tests on a regular schedule, and see where it is going. At some point, you will get the general idea of what is going on and visiting an oncologist for next steps. Clear as mud?

Hey Proto... yup we have very similar histories here... you're my brother in that regard, so great to hear from you.

I setup a Roche Assay test so my doctor and I can compare apples to apples... I'm nervous of course... hopefully it's a false positive.... I'll post the result on this thread once I get it. Thanks for all your support and it's nice to hear from you.

Zzarth

Great update, now go out and enjoy the heck out of Memorial Day.
Michael

Zzarth,
Nice re-test..nice graphs. My advice, be happy, don't worry.

Wings