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Posted 11/18/2023 4:34 PM (GMT 0)
Are PSA measurements below 0.1 ng/ml worth the stress if they’re inaccurate? I’ve noticed others on the board who have been given PSA results above non-detectable and then later given subsequent PSA results with undetectable values. This last September my semi-annual test results came back at 0.08 ng/ml above the normal undetectable value of <0.02 ng/ml. Once I got past the ‘Oh Crap’ my doctor convinced me to wait until November for an additional test. Sure enough, the test results on November 6th came back as undetectable, <0.02 ng/ml.

These are Extremely Low measurements - less than 20 parts per trillion. I noticed that Dr Scholz’s lab only measures to 0.1 ng/ml.

I know we all want to know what’s going on earlier rather than later, but if the results are questionable is it worth the stress??
Posted 11/18/2023 5:06 PM (GMT 0)
Its a very good question, and in my opinion, its a personal decision, everyone has a different comfort level.

In my case, I was undetectable for 2 years then became detectable, using a test that measures down to .02. At first I was at just .02, then it slowly continued to climb every single time I tested, at 3 month intervals. I ended up pulling the trigger on SRT/ADT at .08, based on a very clear trend along with 2 RO's citing studies showing that earlier is better.
Of course, as per your remarks it could have gone to something like .03 and then dropped back to .02 or even <.02 and caused me a lot of unnecessary stress. As it turned out, in my case it caused necessary stress, and I was able to react earlier, and so far so good (knock on wood).
Posted 11/18/2023 9:41 PM (GMT 0)
Doug - IMHO radiation patients should just be doing standard PSA monitoring with <0.10 cutoff, too many reasons for variances. The stress factor is just not worth it for suspect information that you can't do anything with.

You can see from my history that I have been only doing <0.10 testing. I was going to switch to more sensitive testing after surgery but then decided to do adjuvant radiation as my pathology was a little worse than expected. End of my consideration of more sensitive testing since I can't do anything with a <0.10 value except worry about it.

My Uro and RO both expressed a concern about high sensitivity testing and the anxiety it causes and were not big proponents of it. Even for surgery only patients, what is one to do with a <0.10 value? I am not sure getting a head start on worrying is worth it although I can understand why many do it.

In my case, I can make the change to annual testing this year which is a stressful decision by itself regardless of test sensitivity. I have about 6 months to think about it...
Posted 11/18/2023 11:41 PM (GMT 0)
Mumbo, while I am happy and believe I benefitted from being tested down to a limit of .02, I agree with your point about not using highly sensitive tests for radiation patients.
When I transferred my care to MSKCC to deal with the SRT+ADT, I found they test only down to .05. A bit more sensitive than what you suggest, but less sensitive than what I was used to. I asked about it and the NP told me pretty much what you stated....that anything under .05 is meaningless at best, and can create unneeded stress at worst.
I thought about it a lot and I'm good with it. I doubt anything would be done, not even scans, unless and until I get over .2 anyway, so I don't need to know if my PSA suddenly rises to .03. Honestly I don't need to know if my PSA gets to .1, I think.
Thats a conversation I will have in the next year or two, God willing, when I ask MSKCC to cut me loose and I go to test elsewhere.... at what point will a rising PSA, in the setting of post SRT, become actionable. That is the level of testing I want to go to.
Posted 11/18/2023 11:50 PM (GMT 0)
My doc's practice (five uros) uses also uses an in-office Labcorp assay that tests down to 0.05 with the exception of a very few patients (like me) who have their blood draw sent to Labcorp for their 3-decimal uPSA test.

Djin
Posted 11/19/2023 12:08 AM (GMT 0)
As a surgery-only patient, I opt for the ultrasensitive test for more time to plan in the event that I need further treatment. I don't want to see a sudden 0.13 PSA result then feel I have to put it into high gear to find a decent RO medical team. Gradual ultrasensitive increases would allow more time make the proper preparations. For that reason, I always remind my Medicare PCP to order an ultrasensitive test for my annual. The VA does it automatically.
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