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PSA Test 6 weeks after surgery: Which Test To Get?

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Posted 8/23/2017 8:54 PM (GMT 0)
I have a question. At the 6 weeks after surgery point I am suppose to go in for a PSA test. However, I was given a prescription for a "regular" PSA. I thought that an ultrasensitive PSA would be better, called a PHI. Is it a matter of 3 digits to the right of the decimal point versus two? Should I hassle them for a new prescription for the higher sensitivity one? Does it matter at this point? My margins were negative. Or is it an insurance issue?

Thanks,

Nick
Posted 8/23/2017 9:11 PM (GMT 0)
Ha, now there's a question. Having had both and the associated concerns about volatile (but totally statistically insignificant) numbers....I'd go with normal.
Posted 8/23/2017 9:39 PM (GMT 0)
I got into a debate with my oncology urologist concerning this question. He was trained at MD Anderson and said no one there used the ultrasensitive PSA. He said it didn't make any difference on the outcome since only 0.2 ng/ml was important number on moving on to salvage therapy. He said it ultrasensitive PSA creates additional anxiety.

But being an engineer I want the additional digit. Even though "noise" or "jitters" can cause some fluctuations, I wanted to see the trend if it moves upward. I finally talked him into the post-PSA test.
Posted 8/23/2017 11:16 PM (GMT 0)
You want an ultrasensitive PSA - not a PHI. PHI is something completely different.
Posted 8/23/2017 11:17 PM (GMT 0)
Yes, you should get a PSA test.

Andrew
Posted 8/24/2017 9:27 AM (GMT 0)
If you are looking for undectectability, i.e., a "<" in your reading, a standard PSA test will give you just 1 digit to the right of the decimal point, so undetectable will be "<0.1"

Undectectability on an ultrasensitive PSA test will give you 2 or 3 digits to the right of the decimal point e.g., "< 0.03" or "<0.006". 3 decimal places of precision is sometimes referred to by labs as a "3rd Generation PSA" test.

Note that some labs do not even call it an "ultrasensitive" test. Quest, for example, calls it a "Post Prostatectomy PSA test"
Posted 8/24/2017 10:30 AM (GMT 0)
There is evidence that starting SRT earlier -- as in, when it reaches 0.03 -- has better outcomes compared to waiting until it gets to 0.2. That makes me think the untra-sensitive test is the way to go.
Posted 8/24/2017 11:19 AM (GMT 0)
My surgeon at Johns Hopkins wanted me to get the regular test 6 weeks post surgery. But my family doc ordered the Ultrasensitive. Since the script read "post prostatectomy PSA" I did not even realize that was what I was getting. Was I relieved when it came back <0.006.

I am going with the ultra sensitive from here on out. Having survived 2 other life threatening cancers, I am used to testing anxiety. I would rather have more info than less.

As mentioned upthread, >0.03 predicts ultimate BCR (traditionally >0.2 by regular test). Might as well be able to start therapy earlier or at least have time to get your mind ready for BCR if it is coming.
Posted 8/24/2017 4:50 PM (GMT 0)
Knowing your propensity for worry, Nick, I'd say it doesn't matter. You're getting another PSA at 12 weeks, right?

As for me, I'm getting a uPSA at 8 weeks.

Good luck, my friend, and RELAX.
Posted 8/25/2017 1:47 AM (GMT 0)
Nick,

Since we have the same surgeon I can tell you what happened to us. As you know at the UofC they only test to <0.05. The PA told my husband to tell me not to seek the uPSA, but I did it anyway. I was not comfortable with only seeing <0.05 and nothing lower.

I first went to our PCP and he was more than happy to order a PSA for us but the lowest he could test to was <0.01, better but still not the uPSA I was after. What I ended up doing is ordering the uPSA online for $109.00. I go online, order the test, pay, and print the lab order. Then I go to the LabCorp website and book the appointment. After that, he just shows up with the lab order and it's all paid in full. There's no insurance and no doctors so the best part is...

The results come right to us. No more waiting for the doctor to release it, calling the PA to ask if the results are in, none of that. It's pretty darn awesome! We just had our 6 month blood draw yesterday. His appointment was at 8:00 am and by 8:30 am today the results were posted.
Posted 8/25/2017 8:28 AM (GMT 0)
The standard 0.1 lab test is what your doctor need to do the follow up on your treatment right now. But YOU might feel better with a "<" from more sensitive test, not for any clinical reason (at six weeks) but to reduce the anxiety level. It could also be the opposite if not <0.006!
You could have the sensitive test at the 12 weeks test, it wont make any difference clinically.
Posted 8/25/2017 2:08 PM (GMT 0)
MD Anderson (as somebody mentioned) and the VA only use the 'standard' PSA test. My test results have been < 0.1 since six weeks post RALP which they consider undetectable.
Posted 8/25/2017 2:30 PM (GMT 0)
Always a source of debate. The doctors can't even gree on when to take action. You say your Dr waits till .2, and that is in concordance with AUA guidelines. My Surgeon waits till .1, but STILL uses the uPSA. And the RO I saw t MSKCC says he doesn't believe in waiting for a magic number like .2 or even .1, he just wants to see a CLEAR trend.

What I think seems to get lost in the conversation, at least I've never seen it mentioned is thiss.... sure, the uPSA causes more, and sometimes unnecessary , anxiety. I can attest to that. But it also gives more data points and allows one to pick up a trend earlier in the process, if you do the regular PSA, and don't see any rise until .1, or worse, .2, then you've got to start the process of getting an appointment with an RO, or maybe 2 of them, exploring options, doing whatever testing they want, planning treatment, etc.
Meanwhile, PSA continues to rise.

I vote for uPSA
Posted 8/25/2017 4:49 PM (GMT 0)
I vote for uPSA also, and for the same reasons.

Prato.....that was the shortest break on record ;-)
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