Help with psa reporting

I am on a standard assay with clinical labs of Hawaii. My only 2 post/op psa have been 0.0, typed that way on the report. My understanding is that the standard assay lowest detectable level is just less than .1 . Im up on the ultra sensitive stuff, but with good path report, dont want the knowledge, cause I am relatively sure, any recurrence would be systemic and would really need to be conviced by rad onc to do srt. I don't think I would do any HT till psa got to 9 or 10. Im real close to 67 and believe I have that luxury. I know, I say that now..... Don't most std assays report it on paper as undedectable or <.1. Isn't the lab opening them self up for a law suit, when they report on paper as 0.0, when it could be anywhere to .09. MY first could have been .04 and the second could be .08 a 6 mos doubling time. I asked my Uro about this, he really didn't have a good answer, but what he did say was at the various conferences these folks go to, He asked if a doubling time at that low a level was significant. Most hedged, but when He asked if they were involved would they get SRT at that level, most said No. I guess that could be another thread. Is doubling time significant at that low a level. Im aware of the .05 and .1 cutoffs but am also aware of 3 sequential .2's for official BCR. Without diminishing the real heartache of this disease, it really at the same time, is quite fascinating. Please take the last sentence in the positive spirit in which it is stated, Aloha!!

Short answer: You have a great pathology report...as good as it gets! You made a great choice having surgery! The standard test, with the lower detection limit down to only one decimal place should absolutely be all you need. Time to get on with life!

Thanks gents, Im feeling real good about it, specially after the last one. Hope I never have to do HT, cause I get pretty emotional with Joy, macho as I be!!!

Not sure what a statistcal zero is. Maybe sone of you math guys can educate me.

It seems to me it is either a zero or not. Even my ultrasensitive is expressed as <.01, which still may not be a zero.

We hear discussions on here of natural PSA. It is a protien produced by prostate cells. If we have a prostatectomy, we have no more protate cells, theoretically.

Any PSA level be it .01 or 10, must mean we have either left over prostate cells, or cancer cells producing it.

If we say or the experts say that numbers less than a certain level are insignificant, I can sort of buy that, but PSA amounts greater than zero must mean something,m it would seem.

My guess is that any PSA result with "<“ (less than) symbol prior to the number just identifies sensitivity of the measuring equipment. If someone has a different interpretation, please let me know...

Sharp

Casey, I don't think it would be too tough for you to understand what was meant among PC survivors as a "statisical zero". Just because you don't like or understand the loose usage of the word, doesn't mean its invalid. Due to testing standards, normal tolerances within tests, etc, there isn't ever going to be a .00 reading, with or without your prostate in place. So the generally accepted "you are ok" range for a post-surgery PSA reading is anything <.10.
so that would range from .01 through .09, thus becoming the benchmark for a "statisical zero". That's all, you don't need to make it any more or complicated than that. I believe most men here understand that. Stop splitting hairs, it's a general figure of speech.

David in SC

IMO there are enough explanations of the meaning that even the newest of the new soon finds them, I certainly did. Anyone who has had any bio/chem classes is familiar with the meaning of "significant figures" and the limits of testing equipment, other numbers types will recognize "margin of error".

All in all the best we can do is make sure the newcomer is aware of the ACCEPTED TERMINOLOGY and move on. No point in getting upset over terms that almost everyone uses and understands.

David,

Thank you for helping all of us with the basics of PSA reading. I am still struggling with the unanswered question: Does PSA result with "<“ (less than) symbol prior to the PSA number identity sensitivity of the measuring equipment, or it just tells us that PSA does not exceed that number?

For example if it says "<0.06", does it mean that PSA level can be between "0" and "0.06", or it just says that this equipment cannot read PSA below 0.06?

Regards,
Sharp

Les,

Thank you for helping to clarify my answer with Sharp. It was a good answer. It is common knowledge here at HW, and we certainly explain it often to our new friends, that when we talk about the "zero club", its not literally a .00. It's undetectable based on the standards of the particular test.

David in SC

But of course, mi thread, su thread lol

Carlos,

Medved has a lot of data on this. His data also showed wide variances between techniques.

This subject has been a hot button for me since deciding on surgery, and I was consumed with reading about what to expect and what might follow from various readings.

This report was particularly relevant, summarizing succinctly what other readings implied:

http://webdoc.nyumc.org/nyumc/files/urology/attachments/shen_lepor_taneja.pdf

If you have no prostate and no cancer then your PSA should be close to zero, though zero is not possible to reach. The recent conferences had published reports of new tests that could measure PSA with 4 zeros after the decimal point and perhaps these tests will spur studies of realistic values and ranges to become published and refine the "common knowledge" in the future.

I get sent to Quest labs which has the "Post-Prostatectomy" PSA test (Analytical sensitivity: 0.01 ng/mL) and has to be sent 500 miles south, so clearly not used as often. The regular test is processed in town. It costs a little more but still under $100 before the insurance. I have to insist my urologist write the slip for this test every visit because he thinks "nobody uses it". I wonder if ignorance is bliss.

I got the impression a "standard assay" test would be reported as <0.1, 0.1, 0.2, 0.3, 0.4 etc.

With a test that is only accurate to tenths of a point  a 0.1 might include the range 0.06 to 0.14   .

If 0.20 is a recurrence, the standard assay test for me was in a class with "drive by appraisals" or "the fish was longer than my arm".

After removal of the prostate the PSA level is going to drop, and it seems very significant, when and how far it drops, what the low point (nadir) is and if it goes up, when and how fast it rises.

One can not really know this, or pass this info to an oncologist who might ask,  if there are not ultrasensitive samples taken at regular and frequent intervals. In a lot of cases it's not necessary to even wait the 3 months, after surgery,  to see the PSA burn off and reach the low point, such that conceivably, it may have started back up again by the third or fourth month and if you were not tested you missed your low point.

Also of interest is the statement near the end of page 3: "...PSA nadir was achieved at a mean followup of 10.4 months."

Determining the patterns on nadirs, and times to recurrence, and local vs. systemic recurrence seem to be tied to trending info on PSA levels.

Might as well take a close look if you're gonna look at all! What you do with the info is entirely up to you but it gives you more time to work out the plan for the next step!