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What do PSA numbers from Mt Sinai really mean?

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Posted 9/26/2015 12:15 AM (GMT 0)
When my surgeon (Tewari) was at New York Presbyterian, the PSA readings for 2 or 3 years after my RP were a comforting "< 0.008 ng/ml". When he moved to Mt Sinai, the readings were either "0.00" or "< 0.02" for a while, though I was never able to get a straight answer about the nominal threshold of the measurement. My most recent reading is "0.1", which is not comforting.
CORRECTION: I should have said "0.01", which is of course better though still confusing. My apologies! But the questions remain.]
When I asked, the physician's assistant said (verbatim) "the Mt. Sinai lab uses 0.00, 0.01 and <0.02 interchangeably and they are all undetectable PSA levels and essentially all mean the same thing." Well, maybe. Does anyone have a better answer or explanation? Should I be concerned? Many thanks to the many helpful people here.

Sal

Post Edited (SalM) : 9/26/2015 5:41:45 AM (GMT-6)

Posted 9/26/2015 12:32 AM (GMT 0)
That's VERY strange. I really doubt the information is correct. Different labs use different assays, which have different lower limits (hence different numeral for undetectable).

Normally, a "<" symbol is used to indicate undetectable (ie: below the lowest number they can read).

But you are talking about one lab, I assume, with one assay, I assume.

That answer makes no sense to me. Maybe someone else can shed some light on this.

Prataman, wasn't Tewari your surgeon? Do you use that lab?

Mel
Posted 9/26/2015 1:09 AM (GMT 0)
If and when it reaches 0.1, THEN you can start worrying about it..
Posted 9/26/2015 2:26 AM (GMT 0)
You are being a victim of ultra sensitive testing. No sense or reason to have PSA readings that go to .XXX, all it does is cause needless anxiety to the patient, in this case you.

As long as you are at or under .10, I wouldn't give it another thought. You are doing great, don't let these varied testing formats get in your head. Best advice I can give you.
Posted 9/26/2015 11:44 AM (GMT 0)
Thanks to all for weighing in.
Unfortunatley I goofed in typing the original query; my apologies. The strictly non-zero value was 0.01, which is indeed very close to the noise level in ultra-sensitive tests. But the question remains of whether one should read anything into such a measurement. (Another thread suggests that 0.03 is a threshold where action is called for.)
Sal
Posted 9/26/2015 12:30 PM (GMT 0)
For all of us RP guys who have not yet had SRT, the uPsa test can be helpful in making the decision when to start secondary treatment. It seems most studies indicate a Psa level of .03 will ultimately lead to a BCR, (something like 80-90% certainty), and eventual SRT. If earlier SRT treatments increase the chance of cure, then it seems the uPsa is a justifiable tool to help decide when. After secondary treatment, I don't believe there is any further need for the uPsa.
Posted 9/26/2015 1:18 PM (GMT 0)
Sigh. Another thread in the endless discussion of what the ultra-low test reveals. It appears that there really is no STANDARD reporting system. At some point, agreement will need to happen. And then, as soon as the majority of labs have the equipment to test down to <0.01 and start reporting consistently, a 'latest and greatest' instrument will come online that will get the standard down to <0.002, and the confusion will start all over again.

At some point we have to agree on what "good enough" means.
Posted 9/26/2015 2:17 PM (GMT 0)
Hey Sal, welcome to Healingwell, Compiler is right, I also used Tewari, in January of this year. When they did my 6 week post surgery blood draw, Mae, the NP, told me to things, first, they don't give the PSA results a second thought unless it gets to .1 (not .01, but .1). I'm not sure that still holds in light of latest research posted here, it does seem like .03 is the number.

The second thing she told me was that Mt Sinai doesn't ALWAYS use the < sign. My 6 week test did in fact come back at <.02. , but I decided after that, to start using Quest Diagnostics. I go about 10 days before my appointment and within a week, I get the results, on my IPhone (or on the quest website) And they always use the < sign. So if there is anything to discuss, I know it at the time of the visit.
I asked Mae , she said that they do have a number of patients who use quest and they are fine with it. So if you aren't comfortable, maybe switch.
Posted 9/27/2015 4:40 PM (GMT 0)
Thanks, Pratoman. I appreciate the suggestion of using Quest; it might provide more consistency and, if nothing else, it's less travel time since I don't live in NY.

Sure would be nice if reporting were consistent, especially within a single institution. Patients would be happier and it would cut down on people asking whether some change is significant.

My history and numbers look pretty similar to yours except that I'm 4.5 years after surgery (and a few years older!). So far all is well. I hope you follow a similar track.
Posted 9/27/2015 6:05 PM (GMT 0)
Thanks Sal, sure hope so.
Just a heads up, on Quest, after I posted in this thread, some new info came up, that concerns me regarding Quest. You should probably read it, here is the link...
www.healingwell.com/community/default.aspx?f=35&m=3388582&g=3504426#m3504426

Look at the post on 9/25, about 12 posts down. Worrisome about Quest. I am going to try to contact someone at Quest regarding this issue tomorrow, (Monday)
Posted 10/1/2015 11:31 AM (GMT 0)
Pratoman, thanks again. The other thread seems to imply that there's a fairly widespread uncertainty about whether "<0.01" is meaningfully different from "0.01", or is just an artifact of reporting mechanisms. I still dont know whether "0.01" means "undetectable" or one step above. And how does either of those relate to "<0.02"?

In the interim, I got a test at NYU Langone that came back "<0.01", so I'm not worrying, but it sure would be good to understand what the various reporting schemes mean so that others could be either reassured or begin to take action. Does anyone else have data from Mt Sinai or NYU that might help clarify?
Posted 10/1/2015 6:02 PM (GMT 0)
My physician and Urologist tell me the same thing: 0.0 is a good enough/normal result. Carrying it down to 0.000, 0.001, etc. is unnecessary (in their opinion. Thankfully, I've been 0.0 consistently since my da Vinci procedure 6 or 7 years ago.
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