Low Level PSA 6 years after Prostatectomy

Hi, I'm new to this forum and apologize if this question has been asked. I was diagnosed July 2013. Prostatectomy in August 2013. Gleason 6, T2C, zero margins, 4 of 12 samples positive, overall 25% of prostate, both lobes. Three years ago, PSA went from <0.1 to 0.1. Doctor said to wait, nothing to do at that point and 3 months later, it was back to <0.1. My recent test was 0.1 again (almost exactly 3 years after first 0.1 test). Not sure what this means and my doctor can't explain it. Is it normal to bounce like this? Not sure if I should be worried, but hard not to keep thinking about it. Any advice would be appreciated or if anyone else has gone through this.

Thank you,
Terry O.

TerryO - What do you really want to know at this point after so many years? Not much to do short of worrying too much. I would not consider this a "bounce" since that typically does not happen after clear surgery. This site is full of discussion of various PSA typos where the "<" is left off or numbers are transposed which causes lots of anxiety. Doctor's previous advise probably still applies and see what happens on next test. Are you still getting PSA on 3 mos basis or 6 or 12 mos? You or doctor could have the lab review their results for typos or ask for another test in 3 or 6 mos as a check if you are on the annual testing plan after so many years.

If you wanted to really investigate, you could ask to get the higher sensitivity PSA tests that go down to 0.02 or so and watch those readings for a while. They are so sensitive that they will pick up you just thinking about PCa so be careful, haha!

Good luck

I agrre with others. After 6 years and such a good path report, loosing the minus sign while being still at 0.1 should not worry you. Even if a biochemical recurrence evolves (I hope it will not be the case) most chances are that it would be slow and not so much aggresive.

I'm 56. I was 50 when diagnosed. PSA prior to surgery was 5.2 and was steadily rising over about a 3 year period which is what triggered the biopsy. I also had a bone scan done prior to the surgery and it was negative. I still have a lot of pain and occasional difficulty urinating, but doctors haven't found anything so I just live with it. Otherwise, just had my annual physical and doc said I'm very healthy. After being diagnosed, I started eating better, lost weight, got back into running and generally taking better care of myself.

mattam said...
Terry,
If you want to really generate some anxiety have your doctor order an ultra-sensitive PSA test.😉

I don’t think you have anything worth worrying about.

Ditto.

" Three years ago, PSA went from <0.1 to 0.1. Doctor said to wait, nothing to do at that point and 3 months later, it was back to <0.1. My recent test was 0.1 again..... Not sure what this means and my doctor can't explain it."

No way of knowing, of course, but here is one thing it possibly means: Since you first lost the < indicator 3 years ago, gained it(the "<") back before losing it again, that means at the worst case you have advance from a .1(when you 1st lost the < ) to a .1 over 3 years. So that is a pretty darn slow advance, actually none. So it could all well mean that 3 1/2 or even 4 years ago, your PSA was .07 or .08 or .09( all are < .1). Which if that is the case, that means that any rate of growth is very slow indeed. For all you know, you have only managed to go from a < .1(which was what, .09? who knows?) to a .1 in well over 3 years, or maybe 4 years, who knows?

I'm sure your doc is not very excited about such an advance, especially as it went back down for a while, when compared to your risk. Possibly because he has not seen a true contained G6 die of PC, or even make it to mets. If he has, you can bet it has been darn few. My URO- been in a busy practice for 20-30 years- told me he had a surgical path confirmed G6 that was undetectable for years, then got tired of fooling with all the PSA checks, and they lost track of him for quite a few years. Finally showed up with some symptoms, and he had PC mets. But he told me that story as a super rare event, the only one he has ever seen, one for which he had no good explanation.

But I'd say you are still in good shape, and no need to worry unless you start an actual trend upwards. Even then, with your low risk, you should be able to easily deal with it.

Post Edited (BillyBob@388) : 5/25/2019 5:56:34 PM (GMT-6)

Thank you all for the thoughtful responses. It's greatly appreciated. The last 6 years have been a roller coaster because of the PC and the resulting ED, occasional incontinence, urethra and anal pain. I'm pretty lucky overall and am not going to worry.

And don't forget, some vitamins and supplements can also cause false PSA readings (B group in particular apparently). Worth ensuring you haven't taken anything for at least 48 hours before your next test. Good luck!

TerryOh said...
Thank you! I didn't know that. This is useful information.

Yes, for sure, avoid biotin that is found in many common vitamin/mineral pills. Here is what LabCorp documents for its 140731 uPSA test:

"This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample."

As to your original question about psa value moving back and forth between .1 and <.1, here is the deal with my uro and me. He uses a standard PSA test that *only* shows values as <.1, .1, .2, .3 etc. For any "true" blood value of <.05, the report for the test shows "< .1". For any true blood value .05 through .149, the report shows ".1". For .150 through .249, it reports ".2". and so forth. Odd, and irritates me no end. But he uses his test, and I get my own uPSA test from LabCorp and just don't tell him unless it comes up in a visit.

So my own early Dec. uPSA showed .048, and a week later, my true psa was probably .051 or so, and uro's standard test reported ".1". I went off my testosterone shots the next week (my own accord) and my own monthly uPSA tests since have been mid .030s or about. So my standard test for him this Fri. before my appt. following Fri. will almost surely report out as "< .1".

Maybe your doc uses a similar (imho useless) standard PSA test. So you see how easy it is to jump back and forth across the reporting values for some standard PSA tests. I just will never agree with the medical profession's penchant for hiding important information from the patient. Because we can't handle the truth? -- (sorry, Jack Nicholson).

Hope this helps.

Robert