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Declining PSA Post-RALP, But Not Zero

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Posted 2/22/2023 11:12 PM (GMT 0)
Today I got the results back from my third ultra-sensitive PSA test post-RALP. I have a friend who had the same surgery, he went to 0.000 on his second test! Mine keeps creeping down -- the test results today showed 0.008. Previous was 0.010, before that 0.012. Why the slow creep?

I have ultra-low testosterone and desperately need to go back on the injections. My doctor has been reluctant to agree to the resumption of testosterone therapy until he saw lower numbers.

Thanks for any/all feedback.
Posted 2/22/2023 11:22 PM (GMT 0)
Hi AZ. I'm not understanding your signature data. You say there was no EPE, but your were pT3a. The only other adverse finding I know of that would put you as pT3a would be bladder-neck invasion, but you don't mention that. Something seems amiss. (You also don't mention whether there were any positive margins, the status of which is not incorporated in one's pT staging but which is listed separately in the post-op report.)

Your PSA is very low (below 0.010 after a RP is excellent) and you many not have hit your nadir yet. It is not unusually for it to take some time to reach one's nadir after surgery.

As far as your friend goes, I know of no commercial uPSA test that reports 0.000--did you make a typo? If not, he may not be remembering his result correctly. PSA tests don't report a true zero, but rather some positive value preceded by a < sign to indicate that the PSA value was below the smallest value the test can detect and therefore could not be accurately quantified.

Djin
Posted 2/22/2023 11:44 PM (GMT 0)
Hi Djin -- in my case, I was classified pT3a due to what the final pathology labeled bladder neck invasion. However, my doctor said the BNI reading was actually false, because due to a TURP procedure I had a few months before RALP surgery, my bladder neck consisted of all prostate tissue (this was noted in the pathology report). The only margin was a small 5mm area in the "right bladder neck" -- which was all prostate tissue, and removed by the surgeon when the RALP was done. As far as my friend's zero test goes, I actually have a copy of the paperwork in front of me, and it's from Labcorp. Looking more closely, the test says"PSA-Hyb", with a Ref. Range of 0.000 to 4.000. The result is 0.000 ng/mL. My test says "PSA, Ultrasensitive", with the same reference range. Is there a difference between the two tests?
Posted 2/22/2023 11:44 PM (GMT 0)
AZ. You didn't mention which PSA assay test is used. I've been routinely tested using the Labcorp, Quest and VA assay tests, which are all different. I'm always undetectable with Labcorp and Quest. (<.0006 or <.02) The VA assay is Siemens ADVIA Centaur. My RALP was over 7 years ago. 12 weeks after RALP it reported .04. Since then (for the last 7 years) it reported detectable at .01-.02. Up and down but it hasn't changed. I don't lose any sleep over it. It might depend on which assay test you're using. But your levels are super low and moving in the right direction. Great #'s post RALP. Good luck.
Posted 2/22/2023 11:55 PM (GMT 0)
Looking at my Labcorp results, it says "Roche ECLIA methodology". My friend's report says "Access 2 Immunoassay System".
Posted 2/23/2023 1:19 AM (GMT 0)
AZ, here is the result of a search for "PSA" in Labcorp's test menu. I'm not finding the test your friend had, but again, I can't see how 0.000 could be anything other than a typo if we're talking about PSA.

I'd be very curious to see the report, if you could redact his personal info and post it. What wording does it have regarding "PSA" and what it's measuring?

Djin
Posted 2/23/2023 1:31 AM (GMT 0)

DjinTonic said...
AZ, here is the result of a search for "PSA" in Labcorp's test menu. I'm not finding the test your friend had, but again, I can't see how 0.000 could be anything other than a typo if we're talking about PSA.

I'd be very curious to see the report, if you could redact his personal info and post it. What wording does it have regarding "PSA" and what it's measuring?

Djin

I don't see how to attach an image, but here's what it says:
Continuous Sample Report
Access 2 Immunoassay System
S/N 510502
Type/Dilution: Serum 1
Test: PSA-Hyb
Result: 0.000 ng/mL
Ref. Range: 0.000-4.000
RLUs: 6095
Posted 2/23/2023 2:49 AM (GMT 0)
I think this is:

"The Access® Hybritech® PSA assay is a paramagnetic particle, chemiluminescent immunoassay for the quantitative determination of total prostate specific antigen (PSA) levels in human serum, using the Access® Immunoassay System" .

FDA documentation is here. Although the equipment may show 0.000, this report says:

"Results
a. In the sample diluent study:
The three calibrations provided no significant difference for analytical sensitivity, LoB, and LoD and all results were below the published Access Hybritech PSA assay analytical sensitivity value of <0.008 ng/mL (which used Access Hybritech PSA Sample Diluent to establish this claim)."

[LoB = Limit of Blank; LoD = Limit of Detection]

See this report for further details. I'm not sure why the lab report states 0.000. IMO it should be <0.008, the Limit of Detection. The document states that the Limit of Blank is 0.0016. If a sample with no PSA can give you that value with this test, you can't state that a patient's result is 0.000.

Was this done at Labcorp?

Djin
Posted 2/23/2023 3:31 AM (GMT 0)

DjinTonic said...


Was this done at Labcorp?

Djin

That's a good question. In looking at the document again, I don't think it was. It appears to have been processed by a hospital in Tennessee. He may have told me over the phone that he went to a Labcorp facility, but I can't recall.
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