Darn... 0.1 psa again!

I got my 9 month post daVinci PSA back and it is still 0.1 ng/ml.

I just go home from my appointment with my urologist and he said don't start to worry yet. He said 10 guys with my statistics 8 will slowly go up, the remaining two guys could stay between 0.1 and 0.2 or even become undetectable again. I asked him if the PSA level was caused by cancer or remaining prostatic tissue, and he said that is the $10,000 question. He also said that if it continues to go up it could take several years before it becomes. 0.2 which is his threshold for SRT. Having a question on selecting SRT if and when the time comes, my urologist (urologist oncologist) told me that there are a couple highly trained radiation oncologist here in town. He pointed out that a highly trained RO is just as important as having the best equipment (IGRT, IMRT).

I asked him about doing a ultra sensitive PSA. He told me in his opinion, and the opinion of most urologist that it isn't warranted and not diagnostically effective when psa is above 0.1. I mentioned it would be nice to have another decimal place so I can see what the PSA doubling becomes, and he said that PSA doubling times aren't accurate with very low levels of PSA. I understand what he was saying, but I also know that if a my PSA increases from 0.1 to 0.2 in 6 months as compared to 24 months that the faster increasing PSA means the cancer is probably more aggressive than a slow increasing PSA.

So the bottom line he told me is don't worry and don't immediately rush into anything until you have at least two 0.2 (or greater) PSA levels.

Well, Darn is right. You are probably less than .1, but that is as low as can be measured without the ultra sensitive. My Dr. told me basically the same, that ultra sensitive is not much use at low levels. He said that you could take 3 test the same day and get 3 different no.s. I decided to be a worry wart and get the ultra sensitive anyways. It is really your choice on how you want to test, so whatever works for you. I take it that your post op path was still G7? We all hope that you don't see a fast rise and maybe even somehow become a 0. I dont know what your post op path is, but I bet time is on your side. Good luck.

Startech,

My post op pathology was the same, G6 except one small section G6 (3+4). I had a little positive surgical margin (PSM) at the apex (which had some G6) and statistically if you have a PSM that is the location to have it since usually it doesn't become a problem.

Congratulations to you, great number to have in your situation. and I agree with your doctor, some put too much focus on doubling times when you are dealing with PSA numbers well below 1.x, or even .1x. it doesn't mean the same thing, for example, as if you went from 2.0 to 4.0.

Keep on keeping on.

david

Darn. Darn Darn, sure hate to hear this news. Sounds like your Dr. Is on target. I know that it is still unsettling. We are here for you.

Feel free to call anytime.

Cajun Jeff

arrgg, not the news you wanted to hear... Sounds like you have a good plan, watch and wait

I will take your .1 if you don't want it! But in all seriousness, I got all bent out of shape when my PSA went from undetectable to .1. My Uro cautioned me to not worry since it was less than .2 but nobody wants to see a rise, no matter how small. As others have stated you have a good number and I hope it continues that way for you!

I will be the lone dissenter. Let me put on my helmet.

Last time I looked at the calendar it was 2014! We are not back in the stone age before 2000 when PSA test results were a crap shoot below about 0.4. Now the lab machines are capable of 3 digit resolution. More and more guys are getting them. The resolution is 0.003! That is not a typo. You can get reuslts like <0.003, 0.003, 0.006, 0.009 etc.
There are 3 reasons why your doc says 0.1 is fine and not to worry: 1) Because the lab he uses still has an old machine and can't run the 4/2010 protocol or 2) It is not his PSA result. or 3) Maybe your PSA is really down below 0.05 and not cooking. (But you won't know that until you measure it.)

I was a high risk guy in on many levels - PSA 23, 7 out of 12 positive biopsy, 70% PSA doubling time less than half a year. (139 days), EPE, PNI, etc. After surgery my PSA was 0.05 at 6 weeks then 0.04 then it stayed that way for about 2 years until they upgraded the system to a more selective test which reported it as <0.01. For the past 2 years they changed the minimum reported value to <0.02. It has been rock solid.
For about a year and a half I was involved in a study that compared two machines: the Roche Cobas and the Siemens. My results were and are absolutely consistent.

Given my stats and high risk my docs and I agreed my trigger point for action was/is 0.05. Read that number again. 0.05! That is not even on the radar for a machine with a resolution of 0.1 .
If I want rounded numbers I will round them myself. Give me the data.
By the way back in 2010 we did a study here on HW to see if the cost of the ultra sensitive test was more than the single digit test. about 20 guys responded and we found the pricing was virtually identical. Surprisingly the more sensitive test was actually less expensive here in Rochester NY!

At your next physical tell your doc you want the diagnostic test not the screening test. If your doc says no tell him it might not be important to him but it is important to you and you want the diagnostic test not the screening test. If you have to pay for it, do it. It only costs $85 including the blood draw. $40 if the draw is done at the same time as your cholesterol test.

Look, it's your health - not his. Get the 2 digits test. You are beyond the "Screening" stage. Your test should be "Diagnostic". If your doc is still in the stone age and can't handle the extra digit, YOU can round it for him.

Also make sure to request the full report so you know what machine and protocol is being used. If it is a fossil go to another lab. I repeat, it is 2014!

Good Luck to you
Jeff (No longer a worried guy)

Hey Scooterdu,

How have you been? I hope your results come back as undetectable.

Nick

Lapilot,

Hang in there, as you know our RALP was around the same time, the day after, I too just had my 9 mo check up and I too had high #, but mine went from 1 mo .064, 3 mo .074 to 9 mo .314

So I have meet with the RO, and have my mapping session on the 7th of OCT, and will start seven weeks of treatments shortly after that, still fairly inncontenant, at of course ED, so keep up the spirits it could be worse. All the best.

Thanks gibson00

Now I fully understand how the numbers thing works. No prostate therefore there should be a zero PSA reading.

Up until I was 60 I never saw a doctor from one year to the next. Then I had my back problem and went along to the doctor and that is when she done my first PSA. It was in the 3s back then, 4.2 when she drew blood again December last year.

I hope that lapilot gets the 0 reading his is looking for real soon.

I'm shocked that some Uros think additional treatment is warranted when PSA hits .05 whereas the consensus is that action should be considered at .2 twice in a row. What additional benefit is attained by starting therapy at .05 vs. .2? Where are the studies that prove this?
Bob

Chask
Just goes to show that there is no right way to treat PCa just opinion of each doctor. It will be great when clinical tests come to firm conclusions on the " best" way to treat each type of PCa.