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Posted 3/30/2014 2:32 PM (GMT 0)

clean gene said...
Thanks to both of you. I will have to see my friend and get the ten bucks from him, I won. INCHO welcome back, Is everything ok. I really was concerned for you. I hope you are well. Gene

Hey Gene... I received some news that is alarming in the context of being at healing well. If I had never heard of this site, I wouldn't be all that concerned about an undetectable second reading. However, my number is higher this time around. No panic just a little concern on my end. Next test will give better idea where things are headed for me.

Enjoy your 10 bucks.

I'll trade you scores. tongue
Posted 3/30/2014 2:58 PM (GMT 0)
HI Incho, Did your number go way up from <0.06 or did they get it wrong the first time you got it done. I am praying for you kiddo, you seem like a good guy and hope for nothing but the best for you. I hope I didn't have anything to do with your situation (whatever that may be). Gene
Posted 3/30/2014 3:17 PM (GMT 0)
Clean Gene,

Sorry about your ten bucks. I can't see you collecting.

You are making the false assumption that the test is merely giving an imprecise meaning, like someone might say "a little before 5 o'clock" instead of saying 4:58. Under that (false) assumption <0.03 would mean "pretty near 0.03, but not quite" and would tend to be bigger than <0.01. If that's what it meant you'd be right. But it doesn't and your not.

When a result says "<0.03" it is telling you two things:
Thing 1: The test that was run can detect readings as low as 0.03, and
Thing 2: The test that war run could not detect your PSA.

Which test gets run does not depend on your PSA. It depends on your doctor and the lab he sends the blood sample to.

Oh, and while I am picking nits, "0.03" is not three tenths, it is three hundredths. It's an itsy bitsy amount and you should be happy with it.
Posted 3/30/2014 4:40 PM (GMT 0)

PeterDisAbelard. said...
Clean Gene,

Sorry about your ten bucks. I can't see you collecting.

You are making the false assumption that the test is merely giving an imprecise meaning, like someone might say "a little before 5 o'clock" instead of saying 4:58. Under that (false) assumption <0.03 would mean "pretty near 0.03, but not quite" and would tend to be bigger than <0.01. If that's what it meant you'd be right. But it doesn't and your not.

When a result says "<0.03" it is telling you two things:
Thing 1: The test that was run can detect readings as low as 0.03, and
Thing 2: The test that war run could not detect your PSA.

Which test gets run does not depend on your PSA. It depends on your doctor and the lab he sends the blood sample to.

Oh, and while I am picking nits, "0.03" is not three tenths, it is three hundredths. It's an itsy bitsy amount and you should be happy with it.

Peter, I'm confused. How is less than 0.01 not better than less than 0.03? Yes, the person being tested to less than 0.03 could have a lower PSA than the person being tested at 0.01, however, unless you know the actual number and just have to live with less than it would be better to come back less than 0.01 vs. 0.03 when it comes right down to it.
Posted 3/30/2014 4:42 PM (GMT 0)
I am happy with it. I bet him on the premise that <0.01 was lower than<0.03 and it is - correct? Because 1/100th is lower than 3/100th - right? So I still get the 10 and I am telling the truth. Man, i just can't win with you guys, you are tough. just admit it <0.01 is lower than the <0.03 - no matter what how minute the value is-right? Have fun, today is Funday.
Posted 3/30/2014 4:48 PM (GMT 0)

clean gene said...
I am happy with it. I bet him on the premise that <0.01 was lower than<0.03 and it is - correct? Because 1/100th is lower than 3/100th - right? So I still get the 10 and I am telling the truth. Man, i just can't win with you guys, you are tough. just admit it <0.01 is lower than the <0.03 - no matter what how minute the value is-right? Have fun, today is Funday.

I suppose after pondering what Peter is saying was this...

If two people have the different tests the person whose PSA came back less than 0.03 could possibly be less than the persons who came back less than 0.01 but that is not knowable via the testing capabilities. For example... the person tested to less than 0.03 could really be 0.005 vs. the person who was tested to less than 0.01 who was really 0.006.

One thing we know is the person who is less than 0.03 has the potential to have a PSA in the 0.02 range whereas the person in the less than 0.01 does not. If it was me, I would want to be less than 0.01 without question because the test, by definition, is testing to a lower level than 0.03.
Posted 3/30/2014 5:02 PM (GMT 0)
Incho,

What makes me crazy is when guys will list a number of "undetectable" results and be worried because their PSA is going up and they think they are recurring. If your results are <0.015 then <0.03 then <0.05 then <0.1 you have no idea if your PSA is going up or down or sideways. All you know is that your doctor has been using a lot of different labs and none of them could detect your PSA.
Posted 3/30/2014 6:05 PM (GMT 0)
Peter, so you are saying that when "<" sign precedes any number on a PSA test that it is only indicating the lower limit of the Labs testing ability? If so where can I find that reference. It actually makes sense to me. <!
Cheers, Doug
Posted 3/30/2014 6:14 PM (GMT 0)

clean gene said...
Moderator, I need the 10 bucks so i win. But not to slice hairs, if you get the test done and it goes to <0.01, it's testing to a lower level of psa then if the test went to <0,05 - right? See, so I am not lie-ing to my friend and I still get the $10.

Well, I know u asked the Mod, but if you don't mind an extra opinion: I would say, yes the machine is testing to a lower level, but "no", less than .01 is not for sure Less than "less than .05". Because less than .01 could mean .00999. But less than .05 could also be .00999, or .00099.

IOW, you know it is less than .05, but no way to know how much lower- a little or a whole lot- than .05 it is.

So less than .05 could possibly mean your PSA- whatever it actually is- is lower than another guy who measured less than .01. But no way to know either way.
Posted 3/30/2014 6:25 PM (GMT 0)

PeterDisAbelard. said...
Incho,

What makes me crazy is when guys will list a number of "undetectable" results and be worried because their PSA is going up and they think they are recurring. If your results are <0.015 then <0.03 then <0.05 then <0.1 you have no idea if your PSA is going up or down or sideways. All you know is that your doctor has been using a lot of different labs and none of them could detect your PSA.

That sums it up well right there. If there is a "less than" sign, then all you know is that it is less than. Less than their machine can detect. It could be a minute amount less than or spectacularly less than. Less than 1.0 means they could not detect any PSA, as does less than .1,or less than .01.

Of course, that less than 1.0 might mean that you have way more PSA than you should have considering your treatment, say 0.9. Or it might mean you have .001 or just .0000(zero). Simply can't be known. Can't be known until you reach 1.0 or 1.1 etc. But less than one could be zero.
Bill
Posted 3/30/2014 6:38 PM (GMT 0)

Shaba.Doug said...
Peter, so you are saying that when "<" sign precedes any number on a PSA test that it is only indicating the lower limit of the Labs testing ability? If so where can I find that reference. It actually makes sense to me. <!
Cheers, Doug

I won't be shocked if Peter does not have a reference, but he might. Wouldn't it just sort of be normal use of language and symbols? But probably if you have the manual for the machine, it will say something like "range of measurement .05 to 1000" or something like that.

If my med record indicates I weigh less than 250 lbs, then how much do I weigh? Is there any teaching anywhere that says if you read that, you can pretty well assume I weigh 249 lbs? One thing you would know for sure is: I do not weigh 251 lbs or 300 lbs, etc. But I don't see how you could really tell if I weighed 249 lbs or 125 lbs based on "less than" 250.

But a more likely scenario is: I weigh greater than 400 lbs. That might be seen because a scale in an office might not read more than 400 lbs. But if I peg the scale as far as it will go to 400 lbs, then do I weigh 401 lbs, or 600? Who knows?

I suspect that, as technology expands, the lower limits for PSA readings will keep going lower and lower.
Posted 3/30/2014 7:01 PM (GMT 0)
Bill, like I said it makes sense to me. I was wondering if there was a hard reference to it, or is it something deduced from conversations with people in the know. Personally, I think it (<) should just be ignored. > would get my attention!
Cheers, Doug
Posted 3/30/2014 7:18 PM (GMT 0)

BillyBob said...
I won't be shocked if Peter does not have a reference, but he might.

Prepare yourself for a non-shock. I have to admit I can't find it.

this is pretty close.

It said...
From a strict technical point of view, an "undetectable" reading is one where the equipment failed to detect the marker sought, PSA in this case. These "undetectable" readings are usually reported as "less than X ng/ml", where X is the "detection limit" of the lab, assay, or machine used. As I recall, X = 0.2 ng/ml for Hybritech (one of the original assays, still in use), 0.03 ng/ml for Tosoh (one of the first high sensitivity assays), and 0.002 ng/ml for the DPC IMMULITE 2000 (one of the ultrasensitive "third generation" assays). Therefore, for example, a true PSA level of 0.1 ng/ml would be reported as "undetectable" (less than 0.2 ng/ml) by a lab using the Hybritech but would be reported as "detectable" by a lab using the Tosoh or the DPC 2000. As you know, to properly assess the PSA trend all readings should be obtained from the same lab using the same assay or machine type.

But that is fairly old.

Its a maddeningly slippery topic to Google.
Posted 3/30/2014 7:20 PM (GMT 0)
I can't find it in any of my stone tablets, but the reference grid on the bottom of my lab report states in so many words that < means less than the reporting limit for the test.

It has been so long since I had a < that needed to be explained that I don't have the exact text at hand.

Ignoring the < would be dangerous. The < means just that, something too small for the test to see. That is a very good thing. Without the <, you have a hard number, it IS x.x. It is within view of the test. It is big enough to see. "<0.1" and "0.1" could be very different animals.

I remember having the discussion with several docs and the guy at Bostwick, who all explained it that way. My issue was why not always use ultra-sensitive tests (my uro will not do one), and the answer is always that it creates too much anxiety at a level at which not much could be done about it (at least that my insurance would pay). Some here will argue that, and there are good points on both sides.
Posted 3/30/2014 7:31 PM (GMT 0)
Works for me guys!
Cheers, Doug
Posted 3/30/2014 8:03 PM (GMT 0)
Same here 142.
My doc does not like ultra sensitive tests. He borderline called it worthless.
As long as I see a <, I could care less what test they use.
Posted 3/30/2014 8:13 PM (GMT 0)
OK Guys, Next title for discussion is; Additional Pathological Findings; on your pathological report. Does anyone have; HGPIN or Malakoplakia? I'll bet you don't. I beat you guys on this one too.
Posted 3/30/2014 10:17 PM (GMT 0)

142 said...
I can't find it in any of my stone tablets, but the reference grid on the bottom of my lab report states in so many words that < means less than the reporting limit for the test.

It has been so long since I had a < that needed to be explained that I don't have the exact text at hand.

Ignoring the < would be dangerous. The < means just that, something too small for the test to see. That is a very good thing. Without the <, you have a hard number, it IS x.x. It is within view of the test. It is big enough to see. "<0.1" and "0.1" could be very different animals.

I remember having the discussion with several docs and the guy at Bostwick, who all explained it that way. My issue was why not always use ultra-sensitive tests (my uro will not do one), and the answer is always that it creates too much anxiety at a level at which not much could be done about it (at least that my insurance would pay). Some here will argue that, and there are good points on both sides.

Here is something from www.drcatalona.com regarding PSA testing when you start getting to low levels. It is very difficult, per him, to get accurate reading below... .3 Yes, .3...not less than 0.03 or even less than .1.

Q: After having radical prostatectomy, are 3 consecutive readings of 0.1 normal?

A: Depending upon the assay, yes. It is very difficult to measure PSA levels accurately when they are below 0.3 ng/ml, so for practical purposes, anything less than this is "undetectable." However, trends from zero to less than 0.1 to 0.2 usually are meaningful evidence of recurrent cancer.

----The line that follows the bold line is also germane to the topic. I'm guessing that's why they want to see more than just one test more than .1 before they start thinking recurrence.
Posted 3/30/2014 10:38 PM (GMT 0)
Here's what makes these issues tough for me, personally... My current uro, whom I won't be going to see, again, unless it's to get my medical records was, apparently, not concerned with my 2nd reading of 0.082. He wanted to see me in 4 months. The drcatalona site does say to be concerned with 3 consecutive tests over .1 but that testing under .3 can be difficult.

Depending on what you read or where you go you can see a vast array of opinion. No greater example of that than right here. Some would think I should be panicking and already lined up for SRT. One person stated their doc wanted to pull the trigger at 0.05. I guess alot of this has to do with the numbers from your pathology and your pre surgical PSA. My PSA was not good in the greater than 10 range. That is a threshold for intermediate risk. I come back on pathology with G6 which is a comfort. So, I kind of have conflicting data within my own situation to consider. However, prostatitis likely played a role in my PSA per my uro. Again, I could have someone here thinking I'm in major trouble and someone else thinking it's much ado about nothing.

Here's another little blurb from drcatalona.com... (He believes you can wait until your PSA hits 1.0 before engaging in follow up treatments...I would bet most if not all would strongly disagree with him on that but he's a doctor and we aren't. We are all dependent on what we read and are told through our own personal experiences with our docs. Some will claim Dr. superiority based on institution, number of books, etc. My info is better than your info so to speak. It is a tough thing for all of us to get to a place where we really have a peace about what is right for us.



No Reason To Worry Needlessly
Patients need to remember their math and decimal points in interpreting their follow-up PSAs. No reason to worry needlessly.

For practical purposes, it is difficult to detect PSA when levels are less than 0.1 ng/mL. Therefore, we consider any PSA value less than 0.1 as being negligible. A value of 0.1ng/mL would be considered essentially zero. PSA above 0.1 is usually an indication of cancer recurrence, and treatments for recurrence should begin before the PSA reaches 1.0ng/mL.

We get questions from worried patients who have a follow-up PSA of .04. That is considered negligible. If it were 0.4, then that would not be considered negligible but even then, before any treatment decision, the test should be taken again to ensure that the result is not a laboratory error.
Posted 3/30/2014 10:42 PM (GMT 0)
Incho, I like the Dr.Catalano site, don't you? He really seems to know what he is talking about, not that I would know if he didn't know what he is talking about, you know what I mean. So, what are you saying, or should I say, what exactly is he saying? Is he saying that it is not unusual to have a undetectable number, 4 weeks after surgery and than 3 months later have a 0.1 or 0.3 ? Man, I'll tell you, I am a big time beer drinker and I have been good since surgery but I think I am going to start again. This stuff is enough to make your head spin. Please post the interpretation of Dr. C's statement, because I respect him. Thanks Gene
Posted 3/30/2014 10:58 PM (GMT 0)
I think he's saying that testing below .3, not .03, is difficult. That is why you want to see three consecutive PSA's above .1 before you start thinking recurrence. He is also very liberal in his idea that you don't need to rush right into salvage therapies until PSA hits 1.0. I think he makes some caveats that your pre-surgical and post surgical numbers play a role in how you want to proceed. For example, someone with a pre-surgical PSA that was 3.0 vs. someone like me whose was 12.4 may not have to be concerned with salvage treatment until 1.0. Someone like me MAY want to do it sooner but all the other factors like Gleason score needs to be taken in consideration.

It wouldn't be a good sign to EVER have a PSA over .1, but with fluctuations and lab errors 3 consecutive are needed to ensure correctness. I guess it is possible the same lab is improperly calibrating tests the 3 times you went in to be tested. For me, if I was going to continue PSA testing, I would have several before I committed to doing anything. In my case, I had 3 large PSA tests before committing to a biopsy. A biopsy was requested after my 2nd PSA test came back high, but I wanted a 3rd to be sure and after 3 I could no longer feel that there might not be something wrong so I submitted to the biopsy which ultimately found me diagnosed with PCa.

Two schools of thoughts Gene... Think about it and be educated, or just don't worry about it at all. I try to mix approaches and it's not good. I know a few people who had cancer, not PCa, but two of them have been recurrence free for more than 20 years. I know a few others that are over 5 years recurrence free. The thing that I've drawn from them. THEY DO NOT WORRY and they are NOT the type that would ever come to a site like this. They would find it unnecessary and a thing that would just cause needless concern.
Posted 3/30/2014 11:31 PM (GMT 0)
Gene, what a strange coincidence...I just read a post on healingwell.com...read this... It goes to the heart of what we've just spoken to...

Just wanted to share the good news with you guys - my HW family. John's annual PSA came back undetectable last Friday...and it's been 6 years since his surgery.

When I think back to how we both felt right after diagnosis and for months after we got his pathology report (Gleason 3+4 with EPE), I couldn't project 6 months into the future, let alone 6 years. But, here we are 6 years later and, in spite of the years that have gone by, I can remember - like it was yesterday - how I felt when my husband told me he had prostate cancer.

In June, John has his annual physical with his regular doctor and Dr. Tom always sneaks in a PSA test (his lab uses a more sensitive assay whereas the uro's lab only gives us the <0.1. Last June, the more sensitive PSA test came back at 0.02...and we are grateful for that extra zero.

There's no doubt in my mind that I wouldn't have survived those first couple of years, especially when John's PSA decided to become detectable 17 months after surgery. I'll never forget the kindness shown by so many of you, and the support that you gave to us. As some of you know, John's story is a bit of a miracle in that his PSA went from <0.1 to .1 to .3. We were all ready to push the button on SRT when the third consecutive PSA result came in...and it was back down to undetectable and has stayed there ever since. When I consider what so many of you have gone through or are going through, I realize just how blessed John and I have been.

Just wanted to stop by and share the good news with those who know us, and to let you guys and gals know just how important you are in our lives. Thanks for the friendship, support, and love all these years.
Posted 3/30/2014 11:35 PM (GMT 0)
Incho, I am on the same page as you. That is why I introduced myself to this site with that fine statement; Is there anybody out there that can tell me what really is going on? Why are there so many if's and's and but's with a subject or illness such as cancer? The word alone exudes, Fear, helplessness etc. I don't think anybody intentionally wants to give wrong info because of the anxiety it causes others or at least I hope they don't. Anyway, I like the Dr. Catalano site because I think he just tells it like he sees it and doesn't try to sell needless tests, surgeries or fear to buy his product. Keep in touch.....Hope you are well....Gene
Posted 3/30/2014 11:45 PM (GMT 0)
Incho (what does Incho mean?) Anyway, It shows us both that you never know and endless worry doesn't make it better (or maybe it does) since the hubby got better, anyway you know what I mean. Hang in there, this is some wind storm but hopefully we will all get through it. Gene
Posted 3/31/2014 2:22 AM (GMT 0)
Hey Gene, yeah, I do like Dr. Catalona. Very straight forward.

As for you HGPIN and the other funny word, I had neither but I researched both and wouldn't be worried about either finding.

Inchoation means: beginning... not mature...rudimentary. All the things I was and largely still am regarding understanding the world I now live in. I have learned a lot from the guys here. The mods are very educated folks. Peter, F8, Tudpock, 142...all have been really helpful. Far brighter on these subject than me. I hesitate to answer any questions here because they likely can provide much better information than I can. I'm an intelligent guy but there's a lot to learn about this condition. I've spent many hours reading and learning. Hoping one day to be someone who can really help someone on a consistent basis.

BTW, if you asked my wife what "Incho" meant she'd be sure to put the "less than" sign in front. :)
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