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2nd PSA Post RP - reads <.008 Is the test getting that sensitive?

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Posted 1/8/2017 12:47 AM (GMT 0)
Hello all,

Hope this is not a mistake and it is actually .08 and not <.008. I have never heard anyone report any less than <.01 on here after RP. My first test in August was <.01.

If the testing has got that sensitive and accurate then that is a good thing. See my uro on Monday.

Has anyone else ever received a report under .01 and to three decimal points?

Appreciate any feedback.

Greg
Posted 1/8/2017 12:54 AM (GMT 0)
<.008 is the ideal result for an ultra sensitive PSA test. It means that PSA is undetectable. Bravo for you! May you have many happy returns.
Posted 1/8/2017 3:32 AM (GMT 0)

newtopc said...
Hello all,

Hope this is not a mistake and it is actually .08 and not <.008. I have never heard anyone report any less than <.01 on here after RP. My first test in August was <.01.

If the testing has got that sensitive and accurate then that is a good thing. See my uro on Monday.

Has anyone else ever received a report under .01 and to three decimal points?

Appreciate any feedback.

Greg

Yes, they measure this low, and you are doing as good as is possible. With your original < .01, which was super good in itself, you really had no idea where you were. It could have been .009 or .008 or .001 or even lower. All you knew is that you were less than .01.

And you still have no idea where you are at, only that you are somewhere less than .008, which is even better than what you previously knew. If you think about it, with your new <.008 result, .007 is the highest possible # that could still be less than .008(assuming lab accuracy). This number is only about 25% or so lower than the highest possible # that is still <.01, which would be .009. So you used to KNOW that you could not be any higher than .009(or <.01). Now you know that you can not be any higher than .007( or <.008). So what you are looking at is the difference in a max of .009 and a max of .007.

So you now know that your new max possible is about (roughly) 25% lower than your previous max possible. That is great news, but not really a huge difference. Congrats on the .008! That is super good news! Good for you! Time for you to party!
Posted 1/8/2017 3:41 AM (GMT 0)
Some tests go down to 0.003 or even lower. I don't know of any use for that many decimal points, however.
Posted 1/8/2017 4:38 AM (GMT 0)
Oh they will find a use for it soon enough...A few more studies here and there...a few more papers...thesis's...a use will be found and many will be anxious about whether they should use it or be used by it....right here on this forum...I reckon i,m a die hard on that one...ca-ching...

do you know who they are? answer...the backside of us!
Posted 1/8/2017 11:46 AM (GMT 0)
All it means is that the lab has a new toy that can theoretically read PSA down to that level. Before long, the new standard will become <0.008, and once all labs have that pretty new machine, the next generation will come on the market that will give 4 decimal places and the instrument salesmen will collect another fat batch of commissions.

In the meantime, the debate will rage among the researchers about what it means, all politely stated in dense scholarly papers that will obscure the truth from the people who it truly has meaning for: the patients who don't understand the fine points of the argument. Eventually, a new consensus will emerge that will define the new point where post surgical treatment is required, and more men will be given treatments of dubious value.

Eventually, they will develop an instrument so sensitive, it will be able to detect a single molecule of PSA in a full vial of blood, and whatever value that works out to will become the new defined minimum standard. Until, of course, they start insisting that the only way to be certain that a man is PSA free is to hook them up to a machine that will allow the circulation of his entire blood volume through the detector so they can count the actual bits of PSA that are in our systems. And some patients will insist that is the way to be SURE they are PSA free.

The point of this dissertation? That "zero" is a meaningless number that can never be achieved. It's not, strictly speaking, a number at all. And just because we can (or think we can) measure anything with ever increasing sensitivity, doesn't necessarily add any value to our lives.
Posted 1/8/2017 4:07 PM (GMT 0)
The only interesting level to know about is the level when something needs to be done. Knowing these superfluous three decimals levels will only cause unfavorable phycological pressure on the patients. It has no clinical value at all knowing them.
Posted 1/8/2017 4:47 PM (GMT 0)
Ahh...courage is contagious...no antidote known...fear is on loan..."buba...buba...bad to da bone"
Posted 1/8/2017 10:10 PM (GMT 0)
Hi mine first Psa read 6 weeks after rrp is similar to yours
Posted 1/8/2017 10:38 PM (GMT 0)
No, no!! You want the <.008 figure not the .08. Your test result is essentially telling you "We can test down to a level of .008 ----- you are below what we can see"

The degree of sensitivity is not new but has been around for quite a number of years. As Tall Allen said the degree of sensitivity was .003 but has now gone even beyond that, down to almost half that figure. Whether you want to follow a standard or ultrasensitive regime depends on the type of personality you are. The hopeful "I am sure I am cured and I only want information that tells me that" or the number crunching "Am I cured?" type.
The fact is that the ultrasensitive test gives you the best and most scientific information. A patient could receive a whole string of <.1 results following surgery, all the while having slow and steady disease progression. An ultrasensitive test will reveal (despite the minor fluctuations) a steadily increasing PSA well before (up to 18 months) the 0.1 figure is hit.
In newtopc's case the figure of <.008 is a great result and bodes well for the future. As the study below indicates, even with multiple positive surgical margins, having a nadir (lowest measurement) of <.008 indicates that a patient's surgery was highly successful. A figure of <.1 following surgery is not really a true indicator that all the tumour has been removed.

Furubayashi et al. (Oncol Lett. Nov 2014) addressed the implication of ultrasensitive PSA values as regards positive surgical margins.They reported a study of 239 men with one or multiple positive surgical margins. Of those whose PSA nadir was <0.008 ng/mL 93% of men with single or multiple positive margins remained free of recurrence while 46% with a higher value had a BCR. The median follow-up period was 53.8 months. The risk for recurrence was 11X for men with multiple positive margins whose PSA nadir was >0.008 ng/mL vs lower.

Like I said, what you want in the way of numbers really depends on your personality type.
Posted 1/9/2017 6:39 AM (GMT 0)
Allow me to provide my interpretation of the study that BillyMac quotes in the post above. After I saw his post, I read the article. It says that if a RP patient has his post-op PSA drop at one time as low as <.008, that means, regardless of any other adverse findings in the pathology, he is much less likely to experience bio-chemical recurrence. In the study, 93% of the men whose PSA dropped to <.008 did not experience a recurrence. Just one PSA of <.008 is extremely good news.

I had RP in September, and then at 6 weeks I had a PSA of <.008. Two months later, the reading was .01. I didn't exactly freak out, but it sort of ruined my afternoon when I found that the PSA was not longer <.008. This study made me feel somewhat better, however.

FC
Posted 1/9/2017 10:20 AM (GMT 0)
Fiddlecanoe,
You really need to know that the second PSA was done at the same lab, using the same assay, before comparing the two readings.. Even then, you also need to eliminate misreporting the actual second result (for example a result of <.01 at a different lab who then drops the < sign ----- which is not uncommon). I would not be unduly concerned until testing reveals a definite trend and a third and fourth PSA (ultrasensitive of course) in three months and six months time would be advisable.
Posted 1/9/2017 10:30 PM (GMT 0)
Thank you for all the feedback and the note from BillyMac is a morale booster!

I am just home from my Uro appointment and he is very pleased with my results.

I asked about the ultrasensitive testing becoming so advanced. He mentioned that the ultrasesnsitive test is a good marker for finding increasing PSA much more quickly. I asked about where the new bar is to be set, it used to be <.04, then <.01 and now we are at 3 decimal points. He says he gets notifications all the time about patients results from across the country when there is a failure in the cure and they are trying to come up with a consensus. He did say that the ultrasensitive is good for that but also gets many a patient stressed on numbers when they can vary post surgery. He says he has patients over .01 and under .2. He says his marker for additional treatment is .2 but monitoring the increase velocity and the patients ability to remain calm impacts when additional treatment gets attention.

I asked about the next generation and what numbers they will aspire to....he said...I guarantee we will have a better way to test for this disease by then. Interesting.

For now we are happy, happy....Had the ED conversation and he says I'm doing well with my partial results to date and made some recomendations. That is for another thread but it was an interesting visit at the adult store for the first time in my life...LOL

Greg
Posted 1/10/2017 12:20 AM (GMT 0)
The last sentence of your third paragraph is quite instructive..especially the last part of the sentence...I will not explain that but leave it to others and yourself to figure out for yourselves...it is quite honest and i would say...the mantra...for most pca medicos in todays paradigm..." believe it or not"........ btw good for you for staying away from the knife for 7 years...your'e gold ...for goodness sakes depart from this forum and live your life like literally hundreds have...Me...I stay for the same reason Willy Sutton said when asked why he robbed banks......metaphorically...which is all this existence is if you really think about it...er...ah...maybe you shouldn't...light can blind...before it reveals...
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