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Posted 6/4/2015 4:00 AM (GMT 0)
Gentlemen:
I have been on pins and needles for the past 3 months waiting to do my next 3 month psa (results came in today). 0.03. Well, it is better than the one 3 months back: 0.04. Six months back it was 0.03 and the one before that was <0.01. So, I am happy (today's result could have been more!). This is all before my 2 year RP anniversary (post surgery psa was <0.01). But, I am just not quite certain what to think about what is going on. By some definitions, I guess I am in BCR with 3 results 0.03 and above. But I have not seen 3 rises in a row. Please weigh in on this. For background I was G3+4 after RP with negative margins, etc, etc. T2C.
Posted 6/4/2015 5:16 AM (GMT 0)
I don't log in often anymore, even though I am an old time member, but had to respond to your post.

Please don't take this the wrong way, but what are you possibly worried about with a 2 year PSA reading post treatment of .03?

You aren't even considered detectable until you reach .10. You are only 1/3rd of the way to the bare minimum. Also, even by the lowest standards, you wouldn't be considered BCR until you had 3 rises above .10 in a row. By higher standards, it wouldn't be until you were above .20, or even higher.

You are doing great, and this is one reason why ultra sensitive PSA testing can be a bad thing. It makes many of you anxious about problems that do not exist. Enjoy being undetectable, hope you stay that way for years to come. Life is too short to worry about worrying about something that hasn't happened, and may never happen. Look upon your good fortune.
Posted 6/4/2015 5:17 AM (GMT 0)
Not sure where you got that definition of BCR. But if it works for you, thats all that really matters. It wouldn't work for me. Bruce Dalkin was my surgeon. Who was yours. Im sure my post op psa was higher than yours for 5 years. .07 being the highest. Into the 6 year…one year after the .07 it doubled to .14.
Im doomed for sure…... shocked ps you say you had a nerve spared…interesting….

Post Edited (logoslidat) : 6/3/2015 11:21:03 PM (GMT-6)

Posted 6/4/2015 8:42 AM (GMT 0)
It's 3 straight rise in a row from 0.1 = BCR
0.03 you are still in "0" club.
No worry.........
Posted 6/4/2015 11:22 AM (GMT 0)
But didn't TA recently post a study that showed benefit to starting SRT at .03???

My Surgeon has told me that they aren't at all concerned unless and until PSA reaches .1 (he does use the Ultra Sensitive test) which surprised me in light of the study TA published.
Posted 6/4/2015 2:15 PM (GMT 0)
There is new research that suggests an earlier start to SRT is beneficial. Hopefully TA will stop by and remind us of the studies on this.

The long held view is that reoccurrence is declared at .1 and SRT is started by .2.

Waiting is difficult, but waiting another 3 months for the next test is likely the best to confirm a rising pattern.

Have you discussed this with your doctor yet? It might good to start having those conversations.
Andrew
Posted 6/4/2015 2:31 PM (GMT 0)
I am in the similar circumstances as you but am 7 years post op. My PSA measured <.015 than hit .02 and most recent .03. My surgeon recommended SRT when PSA hit anything greater than .03. I am not sure what to do.
Posted 6/4/2015 3:07 PM (GMT 0)
Rob, hate to say it out loud, but it might be time to get that referal to the RO and start the conversation.

Andrew
Posted 6/4/2015 5:38 PM (GMT 0)
Rob, I agree with InTheShop.  My doc told me they would recommend SRT at .03, even with my low Decipher risk.  You've made it so long, so it's likely not aggressive.  Yet it looks like things are stirring a bit.  You're still very young so I would be leaning towards treatment.    
Posted 6/4/2015 5:44 PM (GMT 0)
Rob so sorry to hear this news and I agree with Andrew. Get a conversation started with RO.

Cajun Jeff
Posted 6/4/2015 8:14 PM (GMT 0)
ferretx,

I assume your pathological stage was T2. If so, you have no adverse pathological features. This was a situation explored in a recent study, which you can read about here:

Low detectable PSA after prostatectomy – watch or treat?

As you can see, the critical factor seems to be the PSA kinetics.If your PSA exceeds 0.03 and there are two subsequent increases (or it rises rapidly), there may be an advantage to early salvage radiation. You should monitor your PSA at least every 3 months.

The other study you quoted does not apply to you - they were only looking at men who had "aggressive pathology."

- Allen
Posted 6/4/2015 8:29 PM (GMT 0)
Hey TA: Yes my stage was T2 and that study you linked to was the one I remember seeing.
I am on a 3 month testing cycle and will be watching closely.
Thanks for your succinct analysis.
FerretX
Posted 6/5/2015 12:13 AM (GMT 0)
Sorry to butt in but would like to ask a question.
My first 3 years of psa testing was done at the hospital that performed the surgery and was in those 3 years <0.03 the lowest the machine would go.
For the last 2 years my local gp took over and the local lab only reported <1 as they did not do the sensitive test but said they were hoping to in the future.
Apparently they can do the sensitive test now.My last psa was in may and was reported as 0.04.
Should I be concerned or make inquiries?

Thanks,
Mike

Age 57 robotic prostatectomy nov 09 prostate weight 45gm path report gleason 3+4 = 7
clear margins
Posted 6/5/2015 12:19 AM (GMT 0)
Mike,

I assume that was 0.04 and not <0.04. Then you should be monitoring closely as well. If it stays there, and it likely will, there's no reason to do anything.

- Allen
Posted 6/5/2015 1:00 AM (GMT 0)
I still maintain, this is all a " if you build it they will come". Absolute BS sucking more and more folks into the medical system for little reason. fear mongering using studies that are constantly skewed in nobodies favor , hence a vacuum will be created in filled and not by the "good guys" You see it in every institution in america "photoshopping" to get the result intended. Its a medical money machine masquerading as advances in science. Advocates call it evidentiary…in contrast to what??? "All studies are wrong" the leading mantra from all Epedimiologists in every field. Its the nature of scientific study, but woe to those sacrificed till the endpoint is reached. " Damm it Jim its wrong, its just wrong" 'Who's the the bigger fool?…the original or the follower of such.'. Paraphrase Of Oboe won Kenobi. I don't need no stink in evidence… Its all there in front of your "I" if only you could lose the 'i'.But hey… whadda I know?…just enuff…, Im tellen ya …you want me in your foxhole…. I won't fit in a pidgin hole.. Wow…. that was interesting if I do say so myself... tee hee…. ps question to myself …self when are you going to get some cash for your insight? answer…never…it's priceless. yYeah…I gots some ego going on. Post fueled by a 20oz icy cold brewski with an 8.2% etched in glass. Tah Tah…. shocked Ps ….on an empty stomach, after 2.5 hours of sup surfing head hi swells glassy conditions,{ never stopped moving } followed by 2.5 hours of strength and Hardcore squared{ that would be hard core core work for the squares.. Ok I'll stop and eat something so as to be "abbynormal" gosh I hope I have not precipitated a new rule here..

Post Edited (logoslidat) : 6/4/2015 7:22:50 PM (GMT-6)

Posted 6/5/2015 1:52 AM (GMT 0)
I am astounded at how many men recently here that get overly concerned with ultra low post treatment readings, well under the standard threshold of .10 as even being detectable. Now if one is starting at .05, let's say post surgery, and it keeps climbing, that's another matter.

But with ultra sensitive testing, readings of .02-.04, are well in range of normal testing standards. I don't understand the desire to want to go to SRT, considering the risks involved, when there is no positive indication of BCR. SRT will be there, if warranted in the future. So why jump the gun until there is evidence firmly?

BTW, not addressing these exact remarks to the OP, mean this to be general advice, based on first hand experience of having going through major radiation twice within a 10 year period, both times resulting in severe and perm damage to my body.

Remember too, that radiation clinics stand to make the most bottom line profit from their "treatments", don't think for one minute that there aren't RO's that push patients into SRT before its needed. It's a big money making profit center.

Again, not talking about avoiding SRT for bonifide BCR cases. Then, if warranted, you still have to weigh out the risks vs. the results. SRT often does not give curative results, lots of variables, some still say about 40% positive outcome at best.

There's no way I would undertake SRT with post primary treatment readings of only .04 or so. Wait till at least you get three readings above .10, spread 3 months apart, before giving any serious consideration to a secondary treatment. You need to have your doctor, or a RO, explain just how minute amount of PC is in a .04 reading. In that case, undertaking SRT (along with the associated risks/side effects) is like blowing up a small anthill with a double barrel 12 Ga. Shotgun. Even then, you still might not get all the ants, so to speak.

Just something to think about. Some will chime in and say what happened to me was rare, perhaps, but according to my oncologist (not a RO), he is astounded at just how many men are badly damaged by radiation, sometimes taking years to fully show up. In most cases, once the RO is through treating a person, that's it. When the damage starts to show up, they are typically out of the picture.
Posted 6/5/2015 8:44 PM (GMT 0)
Well, I would have a different opinion than some here. I listened to a friend who advised against getting biopsy too early. I think the nearly two year delay caused me to be T3a at surgery. This time around when my well respected world class PC surgeon says .03 is the trigger and my published academic RO says I agree that .03 is time to go. RO says better than 80% chance of good outcome- I went hook line and sinker. No side effects. will get first PSA in mid August. Hope it shows regression. Saw doc out of the lake last week with big new boat named "Let's go at .03". LOL Just kidding- grateful for the great medical care available to many of us here and the knowledge of this great forum.
Posted 6/5/2015 9:39 PM (GMT 0)
The question to ask, whenever these numbers are bandied around, is simple: what is the limit of precision of the test protocol? Or, in layman's terms, what is the +/- of the value?

No analytical test is absolute. Values are ALWAYS expressed as a +/-, and the 'official' value is considered the 95% confidence value..which is the mean value, and the +/- is one standard deviation.

A good guide is the "<" on the minimum result. If the lowest you can go is <0.04, for example, then it's a pretty good indication that the +/- for the reading is 0.02. In essence, using that particular test instrument, a reading of 0.05 would properly be expressed as 0.05 +/- .02. Which means that 0.03, 0.04, 0.05, 0.06, and 0.07 are ALL THE SAME VALUE! Two subsequent samples reading 0.04 and 0.05 are within the quality control margin of error.

What does this mean for us? It means that the best course of action is to ideally have every sample taking under the exact same conditions. Same time of day, same phlebotomist, same diet, same amount of water that day, same amount of sleep the night before, etc. And then analyzed by the same technician using the same method and the same calibration procedure. This can decrease those statistical differences. So does having regular tests over a period of time (the every 3 month rule with 3 changes in the same direction every time).

If I read the OP's statement correctly, said the current reading was 0.03, while the previous was 0.04. The only way to know which one is correct, is to see what the next one is.

I'm with Logos and Purgatory on this one. At what point is treatment truly needed? I suggest the jury is still out on the super low numbers. And the risks are significant.
Posted 6/6/2015 3:55 AM (GMT 0)
I am the original poster on this thread and I want to thank everyone for a spirited debate (and it IS certain all the facts are not in on low level PSA recurrence after RP). My angst stems from this uncertainty and the desire to DO something (the waiting between tests is something I may never get used to entirely). Beyond diet and exercise changes the one thing left to do is to continue to educate one's self on this disease. Some say that SRT is called for soon after the 0.03 threshold is crossed. Others say ultra low PSA testing is fraught with problematic variables and to wait until things get up and beyond 0.1. Certainly, I am in no rush for SRT. Tall Allen, weighed in with a link that sensibly suggests looking at increases and rate of the same. Seems a smart play in that many post RP types with a recurrence of low level PSA may never progress to BCR. My thinking has been clouded by this illness and I needed for others to weigh in. And you did, and I thank you. It really does help to 'talk' things out here.
ferretx
Posted 6/6/2015 10:41 AM (GMT 0)
Hi Ferretx,

I probably should not butt in but you might be interested to know my husband had same scenario for the first few years. Once it hit .03 we hit panic mode. But it stayed there and Purg (David) is right. Hubby now considers himself cured and doesn't think about it at all, although has yearly tests. Just passed 8 yrs since surgery. Good luck with your recovery. Stay viligant but try not to worry too much. If it stays there that's good. As for the worry and the clouds, time does heal .. I guess that doesn't help much either! But it does. take care!
Posted 6/6/2015 12:54 PM (GMT 0)
Monitor it. Take necessary steps. But stop worrying about it.
Posted 6/6/2015 1:07 PM (GMT 0)
Good luck in whatever decision you make. I know treatment and no treatment is a personal decision and you have to do what is right for you. My RO me monitoring was ok. One thing he told me if if he knew the surgeon cut wide margins, he would be more concerned with a rising PSA as opposed to a surgeon that did not cut wide.
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