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Ultrasensitive test debate : rise in PSA (after 5 1/2 yrs post surgery)

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Posted 7/10/2014 4:46 PM (GMT 0)
My boyfriend had a RRP in Oct 2008
age : 50
initial PSA 4.8 in May 08
PSA 7 Oct 2008 (just before surgery)
Gleason 7 ( 3+4)
T3a
Perineural invasion
Davinci at Univ of Chicago/ Dr Kevin Zorn
Chose not to have radiation
only 1 lymph node out of 21 positive
Always had <0.1 psa last 5 yrs
Now last 2 reports LAB shows the 3 decimal point results.
So confusing.
9/13 PSA .027
4/14 PSA .065 ( chose to after getting the ultrasensitve test in Sept 13)
yet shows on report as < 0.1
now that we have a doubling rate in 7 month we are concerned.
Having another test this week.
Thoughts or advice on ultrasensitve psa test?
Very conflicting info out there, but we want to establish pattern before it may reach 0.1 or higher.
Thank you

Post Edited (angeusamike57) : 7/13/2014 7:48:32 PM (GMT-6)

Posted 7/10/2014 7:25 PM (GMT 0)
So you're 5 years, 9 months from surgery .
IMO very sensitive or ultra sensitive will inform you sooner. The tests I take go out to 2 decimal places. Is he considering salvage radiation?
Good luck.
Posted 7/10/2014 7:35 PM (GMT 0)
sometimes the ultra-sensitive PSA test is just an anxiety generator. Have you discussed the results with the doctor?

Many won't be concerned unless it hits .1 and won't start another treatment round until .2. So, even if the worst is true, it's awhile before you need to take any action and you've still got a number of treatment options.

I'd wait for the next test to confirm a rising pattern before doing any serious worrying.

Andrew
Posted 7/10/2014 8:48 PM (GMT 0)
I know where you are coming from. My PSA for 5 years has been < less than .04 (lowest that the machine will read). The 5 year PSA went to new lab and result was less than .01. The 6 year came back at .02. I definitely have anxiety using the ultrasensitive test but I want to know about the increases. For you, I would definitely keep testing and see if the trend continues to move upward which would provide an indication that you may have recurrence. I am not as concerned with doubling time on an ultrasensitive test since the #'s are so small. A change from .01 to .02 would be a 100% increase but in reality is still non detectable.

Please keep up posted.
Posted 7/10/2014 9:02 PM (GMT 0)
Thx guys, We just got the .065 result yesterday.
He called for exact #, not just the " its less than <0.1 , you are good " answer.
I agree anxiety inducing, but also agree that we will be looking for a trend.
My main concern is that he was a:
Gleason 7 , T3a, w/perineural +, 1 node +, but rest of nodes -.
He choose no radiation then, and all Psa since have been <0.1, but he had never been shown a 3 decimal/ultrasensitive score until last year 9/13 .

Post Edited (angeusamike57) : 7/12/2014 9:47:27 PM (GMT-6)

Posted 7/10/2014 9:12 PM (GMT 0)
Hello: I always have the ultra-sensitive test and with the benfit of finding any recurrance sooner does come the added anxiety. It is good that he is having another test this week since that will give you folks another data point. There are a few factors in his pathology such as perineural invasion and 1 positive lymph node that may explain the increase. It is indeed true that he is <0.1 which is the general criterion of everything being fine, but you are seeing a slight uptick using the ultra-sensitive test that MAY indicate a recurrance. Or it may not. I am certainly no medical professional, however, there is one great factor in your favor. The fact that IF this is a recurrance after 5 years; most likely the problem is in the "prostate bed" and there is a good chance that he may be cured with radiation of that area. By having the issue found early as a result of the ultra-sensitive test, he will be treated sooner and this is also in his favor. You will have your answer once the next test results come in. And you are certainly doing all that you can.

Good Luck.

Bill K. from NJ
Posted 7/10/2014 9:18 PM (GMT 0)
yes, it's a concern but before jumping into something new you need to confirm you need to do something. You could schedule an appoint with his doctor to have a conversation about. I don't see any reason that at some point you couldn't get the radiation done if the PSA continues to rise. Most ROs won't do that until about .2 so you've got a ways to go (years maybe, if ever).

I know it's a shock to see rising numbers and it's easy to say don't panic, but...

Hang in there and keep us updated.
Andrew
Posted 7/10/2014 11:45 PM (GMT 0)
I am a big fan of ultrasensitive and my situation is similar. My numbers have been moving up pretty steadily and my doc and the "second opinions" all agree its time for SRT even though have not hit the official threshhold of .2 and then a confirming retest of .2. I think it's good to have a year or two head start, but you have to be willing and able to live with the anxiety. In my case even though the numbers were small they were steadily increasing and so the trend is beyond debate.
Posted 7/10/2014 11:58 PM (GMT 0)
Thk you all for your replies/opinions. Will keep you posted!
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