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2 years post surgery, PSA just hit 0.1 Should I be worried?

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Posted 4/21/2014 12:32 PM (GMT 0)

Hi everyone,

Its been awhile since I was last on, which I guess has been a good thing. It means I haven't had much to talk about until now but my last two PSA tests show that my total PSA is now 0.1. I have been using the same lab (Quest Dia. Siemens Chemiluminescent method) since my surgery and previously all results have been <0.1. I have read all the information that states most Dr. consider 0.2 as a biochemical failure but not much on 0.1 as a result? If everyone feels 0.1 is as low as tests can accurately indicate true PSA then why wait until it hits 0.2 to do anything about it? Is it possible I could still be cancer free at 0.1 or am I just kidding myself and its just a "wait and see" game again until it finally reaches 0.2?

As always, appreciate everyone's feedback.  

Phil

Posted 4/21/2014 1:15 PM (GMT 0)
Hi Phil,

Your current status is that your PSA is no longer undetectable.

I went back to your previous posts and note that you had positive margins.

This latest reading could just be a blip but I think it is important now to be more watchful, perhaps do your tests every three months. It is unfortunately a waiting game as you and your doctors need to scrutinise what your PSA does over time. We have had a case at this forum where a persons PSA went up to 0.3 than decided to drop back to undetectable again.

Wish you all the best,
An
Posted 4/21/2014 1:26 PM (GMT 0)
Thanks An,
Yes the positive margin is what has always concerned me as well at it looks like it maybe rearing its ugly head. If/when it gets to 0.2 where most Dr. recommend treatment hopefully radiation will get it once and for all. just always curious why they wait until 0.2 to treat. if its back, its back why wait?
Thanks for the feedback!

Phil
Posted 4/21/2014 1:40 PM (GMT 0)
Phil, my Urologist says we're using 0.03 as a trigger point for my next phase. I know where you're coming from and tend to agree with you. There doesn't seem to be a consensus on what constitutes membership in the "zero club" as far as minimum PSA.

I am ok with with 0.03.

Cheers, Doug
Posted 4/21/2014 1:47 PM (GMT 0)
Phil, I think I can give you a pretty good example of why it's important to confirm a recurrence before starting SRT.

My husband had surgery (Gleason 3+4 with a single focus of extraprostectic extension). For the first 17 months after surgery, his PSA tests were always <0.1. His next PSA came back at 0.1 (which sent us reeling), and the uro cautioned not to panic and ordered another PSA date a month later. That test came back at 0.3 (yikes!). We began the process of "interviewing" radiologists and after deciding where he'd get his treatment, had gone through all the usual tests (bone scan, another CT scan because the bone scan showed a "hot spot" that turned out to be nothing), and we were all ready to initiate treatment. The uro continued to caution us about pulling the trigger too soon, and wanted a 3rd PSA test to confirm recurrence. Guess what? That 3rd PSA test came back undetectable (<0.1) and has stayed there ever since. Needless to say, my husband didn't have SRT, and just passed the 6 year mark after his surgery.
Posted 4/21/2014 2:14 PM (GMT 0)
Sephie, you make the point that I think should be stated and not assumed. "Don't do anything without due diligence". Double, triple check. Your Uro did his job, he slowed things down and confirmed the need to do nothing, congratulations. I know I and my Doctor will do the same.

Cheers, Doug
Posted 4/21/2014 2:16 PM (GMT 0)
Thanks Sephie,

You are right, that is a pretty good reason to wait! Do you know which assay for the PSA test was being used during your husbands tests and was it always the same?

 

Posted 4/21/2014 2:26 PM (GMT 0)
Hi Phil,
I know what you are going through, the same thing happened to me this year. After all my post-op PSA test came back <0.1 undetectable, in January of this year, my test came back at 0.1. We took another PSA test 6 weeks later and it was still 0.1. Then at the end of March we took another test and it came back <0.1 undetectable again. The same lab has done all my PSA test the past 2 years.

Now the first 2 months of this year I had a bad sinus infection. I was put on antibiotics and the last PSA test was taken after finishing the antibiotics. I still don't know if this had anything to do with it but I remember having to take Cipro after high PSA results before DX to see if that would bring down my PSA. It did, but not by much. It didn't take much to bring me back into the Zero Club this year.

I have an appointment next week with my uro and I plan on discussing it with him. Maybe that is what happened to you.

I agree with An, maybe you need to be tested every 3 months for now to keep an eye on things. I get tested every 3 months since my surgery because of my positive margins.

Keeping my fingers crossed for you! Don't be a stranger around here, I am sure you have a lot to share with the newbies.

Bill from Florida cool
Posted 4/21/2014 3:27 PM (GMT 0)
Phil -- that's the $64k question. if it were me the question would be should i pull the trigger now or if there were one more consecutive rise? good luck to you.

ed
Posted 4/21/2014 3:47 PM (GMT 0)
Thanks everyone, I appreciate your feedback and personal experiences. We have increased my testing again to every 3 months. We will see what happens on the next test in July.
Posted 4/21/2014 4:00 PM (GMT 0)
There doesn't seem to be a consensus on what constitutes membership in the "zero club" as far as minimum PSA.

there may be confusion among potential members but zero is zero. same as it ever was cool

ed
Posted 4/21/2014 8:13 PM (GMT 0)
The probably badly-named Zero Club is based on having an undetectable PSA for a standard test (meaning <0.1 or lower), or after reaching and staying at a low value (does not have to be undetectable) after RT as primary treatment.

All that said, the Zero Club is just a way of being happy for those who get good results.

I'm "in" while on HT, but who would want me in their club while I'm on HT?
smhair
And I'm "out" for now.

As to treatment standards, most say wait for 0.2 for the reasons others have mentioned.
Posted 4/21/2014 8:53 PM (GMT 0)
I had the VA do a PSA test that they reported as .1 , . I was skeptical and got a more sensitive PSA test someplace else that reported .05 . I wonder if a more sensitive PSA test would clarify the issue.
For example, Quest has a "post prostatectomy" PSA test that is more sensitive than their standard screening PSA test.
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