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Posted 1/7/2018 8:34 PM (GMT 0)
It's been about two years since I posted, but have been on and reading. It seems now I'm back given recent developments. I've tried to put all pertinent info in my signature but if something's missing I'm sure someone will let me know. Since my RP almost two years ago to the day, I have had six PSA tests. The first five were done using the Roche Immuno Assay method and were all <0.1. On Jan 2d of this year I had another done using the Beckman Coulter Immuno Assay method and received a 0.1 reading. I was kind of shocked given my post op pathology results which appeared to give me a clean bill of health. Contacted my URO who said make an appt for about a month from now. He said the latest PSA "may be meaningful". When I asked if I should get another PSA before the appt., he said no "we may get one while you're here".

Is there anyone who has experienced this type of situation two years post op? In reading here, it appears I'm facing eventual SRT and after reading numerous posts regarding SRT I'm concerned. It appears that with a .1 I should not be wasting too much time deciding about SRT. Any advice, insight, opinions, etc., that makes this forum so great would be appreciated!
Posted 1/7/2018 8:40 PM (GMT 0)
With your good pathology post RP you probably won’t need ADT with SRT and still have a chance for a cure.
Bob
Posted 1/7/2018 9:15 PM (GMT 0)
Ask for an ultrasensitive PSA next time. You want to confirm it and see a pattern.
Posted 1/7/2018 9:20 PM (GMT 0)
What TA said .
To ANSWER your question, yes, I have had this happen to me.
See my signature below.

Since you have been getting the regular PSA test, not the ultra sensitive, you don't know if there is a trend. It could have been rising over the last 6 months or a year, or more, but very slowly (which would be good) but since it has come back at <.1, you don't know. Your last 3 tests might have been .05, .07, .08, leading up to the .1.

So just retest, now, and then at regular intervals over time, maybe monthly, since it's at .1, until you get a definitive trend.

It's amazing to me how many G3+4 guys seem to end up with BCR. Makes me wonder if it's truly LOW intermediate risk.

Post Edited (Pratoman) : 1/7/2018 7:28:35 PM (GMT-7)

Posted 1/7/2018 10:48 PM (GMT 0)
Labcorp uses Roche. Quest uses Beckman Coulter. I'd suggest going to Labcorp for another test. The sensitivity for the Ultrasensitive PSA test of Labcorp/Roche is < 0.006. The sensitivity for the Post Prostatectomy (Quest's terminology for ultra sensitive) PSA is < 0.02
Posted 1/8/2018 12:59 AM (GMT 0)
TeeItUp, to follow up on WeightLoss post, where did you get your most recent PSA test? The reason I ask is that my husband’s first 4 post op tests were done at Quest and were all reported as <0.1. His fifth test was at Quest and came back at 0.1. His urologist office told him to re-test immediately at another lab, not Quest. He had a second PSA test not even 24 hours after that concerning test result, this time at the hospital lab and it came back at <0.01. The reason I bring this up is that given WeightLoss comment on assay that Quest uses being the same assay as your most recent test was, it is possible you are part of a number of people who have lost their < sign from Quest only to have it reappear when tested at a different lab. Apparently it is enough of an issue where we live that my husband’s surgeon, who is chair of urology at big multi hospital university medical center, tells their Quest lab patients who this happens to that they should re-test inmediately at a non Quest lab. This may be irrelevant for you for any number of reasons, but if you had this test at Quest, it may be worth re-testing elsewhere immediately and possibly save yourself some worry. Good luck
Posted 1/8/2018 1:27 AM (GMT 0)
You can get an ultra sensitive test script on the internet and get tested yourself. ( note: some states or labs do not allow this).
Posted 1/8/2018 12:36 PM (GMT 0)
Thank you everyone for your valuable input! I really appreciate it! Lovit - you have kind of described the situation I'm in. Post Op, I had five PSA tests (non ultra sensitive) through my URO and GP who are both in my health care system (Wellstar). All five were performed by Labcorp (Roche) and were all <0.1. I just had my latest PSA test (six months from last one) and noticed that not only was I a 0.1 but that the test had been performed by Quest (Beckman Coulter). So, your information is very pertinent. I don't know if my health care system switched labs or if they use both or what - but I will find out! I have to go to my GP and get a referral today and will stop by the lab and ask in person. Again, thanks everyone for your information and I will let you know how it goes today.
Posted 1/9/2018 10:22 PM (GMT 0)
Checked with the lab - kind of a lame response from them. When I asked why all of my post op PSA tests had been run by Labcorp (Roche) and now all of a sudden I have one run by Quest (Beckman Coulter) that is causing all the commotion - response was it depends on what type of insurance I have. Given my insurance has been the same (Tricare) since this journey was begun over two years ago, I told them I doubt that was the reason. Next excuse was "it must have been how the doctor wrote it up". Didn't press the issue with them. Contacted my URO via e mail expressing concern and requesting uPSA tests using Labcorps (citing all the info y'all have so kindly provided in the above posts) - have yet to hear back from him.
Posted 1/10/2018 11:46 PM (GMT 0)
Head meet wall...

The parameters of tests has long been an issue. Mine went from reporting thru Blue Cross as <.001 to <.1 thru Cigna... Scared the crapolli out of me. Turns out to be a non-issue. And I get decimals which is why I questioned my general practitioner. What is an issue is when the tenth or hundreth means something in higher risk guys. In the vast majority of cases if you are less than .1 with your psa (<0.1), you are at zero.
Posted 1/11/2018 12:18 AM (GMT 0)
Understood. My problem is that it was always <.1 but now is .1 (the "less than" symbol not present in the lab test results). Discussed with my URO last night and he advises he no longer requests uPSA reports (instead of standard reports) because it causes undue anxiety in his patients (no kidding ). We agreed, however, that the problem of my latest reading being from a lab not used on all previous tests and causing the .1 to show up has to be addressed. Am trying to set up another PSA now and insure that it gets sent to Labcorp. Thanks for your input!
Posted 1/11/2018 2:19 PM (GMT 0)
My buddy had a radical prostatectomy and needed salvage radiation maybe eight or ten years after surgery so he had a biochemical reccurance. Unfortunately PSA can elevate months or years later.
Posted 1/11/2018 3:37 PM (GMT 0)
I've been there, the shock, twice. Once after RP and now after SRT. Yes, do a retest, but be prepared for the case that your PSA really is climbing. Your pathology is better than mine was, and you may find that your PSA stabilizes around the 0.1 point, maybe from some benign tissue left behind. But, if it doesn't, and SRT is in your future, it's not that bad. Much easier than surgery. Be thankful you still have a good shot at a cure and, if SRT is needed, get it around the 0.2 point.
Posted 1/11/2018 4:47 PM (GMT 0)
It doesn't really matter which provider you use (which equipment manufacturer you use), just try to stick to one because there are some minor differences. It's not always completely in your control, and you are not the first one to have to switch test systems. Either are fine; just do your best to stick with one.

Not surprised (for exactly the reason you uro stated) that you haven't had the ultrasensitive PSA test given your final pathology (which should be the primary determining factor on whether one submits to the additional anxiety your doctor described, or not). However, now that there is a possible something to watch (your lost LT sign), your next one going forward should be the ultrasensitive.

good luck!

Post Edited (NKinney) : 1/11/2018 12:31:41 PM (GMT-7)

Posted 1/30/2018 5:25 PM (GMT 0)
Hey Fellas,

Haven't been able to provide any follow up on this as I've been fighting the system for weeks. Long story short, I insisted my Uro give me another PSA and that it be sent to Lab Corps (Roche) for analysis. The results came back this morning <0.1. If I didn't succeed in doing anything here at least I was able to show that results are different from Lab Corps versus Quest.....I hope that I've been able to help someone on here who has or may encounter a similar situation in the future.

Uro says he is not concerned now (go figure) but wants to keep monitoring closely....

Thanks again for all the input guys.....
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