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detectable PSA 8.5 years after RP

will1946
Posts: 10
Joined: Dec 2010

This is my first post to this site. Last week I learned that my PSA was 0.03ng/ml, the first detectable finding 8.5 years since my surgery. My urologist told me to test again in three months, and see him about the results. My PSA before surgery was 5.4, cancer stage T2c, Gleason score in pathology report 3+3. I gather from my reading that a recurrence, given the data above, 8.5 years out, is quite uncommon. Should I suspect a false positive in the test results, and retest now? Any suggestions or observations gladly received.
I should add that all tests previous to this latest one were done in office, and the results were all <0.04ng/ml., the precision limit of that test. The latest was done at an outside lab, with clearly more sensitive equipment. Thanks for your help.

VascodaGama's picture
VascodaGama
Posts: 1515
Joined: Nov 2010

Hi Will,
I can sense Anxiety in your post. But you are far from being considered as having recurrence yet. I am not a doctor but based in my ten years of experience, I would say that; waiting for the next PSA in 3 months is just OK.
Your PSA of 0.03 is within the limits for what it is called remission. It is also within the limits of your previous PSA tests of <0.04, even if you do not trust its accuracy. Many doctors use a higher threshold PSA of 0.10 as a trigger to consider any recurrence. The American Urological Association (AUA) guidelines which are followed by many institutions around the world indicate that a PSA recurrence (biochemical failure) after radical prostatectomy is defined as having a PSA level greater than 0.2 ng/mL and rising, which is confirmed by repeating the PSA test (at least one month apart).
You can read about this in the following site; http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf.
Your status after surgery 8.5 years ago (T2c; Gs6) sets you in the limits of the group of Low Risk Patients too, with no extra capsular extension. Your next PSA will give you peace of mind, until then, enjoy the season and have a good New Year.
Welcome to the board.

I wish you a good result.
VGama

crhoads
Posts: 7
Joined: Dec 2010

Will first, how do you know that your PSA hasn't been .03 for a long time if your old lab only went to .04?

Second, I frequent another forum with a lot of people using the ultra sensitive PSA test. I can't tell you how many times I see this test fluctuate. I have seen people get one reading at .04 and the next at <.01. There are a lot of Dr. That won't use the ultra sensitive test because of the anxiety it causes from fluctuations.

ob66
Posts: 214
Joined: Apr 2010

Would appreciate the address of the site where the ultra sensitive PSA test is discussed as I have had the ultrasensitive since April this year and my 0.05 rise to 0.07 was the basis for having RT after daVinci one year earlier. I am still glad I had it done, but would like to understand all the nuances of the Ultrasensitive test. Have read Dr. Walsh, lurked on this site, but discussion is limited and many times not up to date. Thanks.

VascodaGama's picture
VascodaGama
Posts: 1515
Joined: Nov 2010

Hi OB66
Please do not interpret my words wrongly but the information you posted on your case, places you in the group of guys that may have experienced “PSA Anxiety”. I say that because of your comment of “…0.05 rise to 0.07 was the basis for having RT”.
I believe that there were several other factors (not only a rise of 0.02 in PSA) which contributed for you and your doctor in embarking on an earlier RT.
Surely your choice was very well decided and I respect your way of thinking; however we should note about the many reports of unnecessary treatments taken place because of PSA Anxiety.

The ultra-sensitive PSA tests on the two decimal places are excellent to diagnose earlier prognosis of recurrence cancer. But that alone does not accurately serve the purposes to trigger a treatment. There exits protocols based on realistic data collected and sorted out by scientist from the whole medical fields, which serve as guide lines for treatment practice.
We just follow what we most trust and we are not doing something wrong by lining on the side lines, however, the information given by respected sources are definitively more balanced.

I know of a guy that had is PSA tested in two different assays during one year after RP, and he was surprised for the differences in the results done on the ONE SAME SAMPLE; A Siemens assay would give a PSA=0.04 whether a Roche assay would give a PSA=<0.01. This is a typical case where if one had used a Roche assay followed by a Siemens 3 month later (indicating a non-existing increase of 0.04) which could be taken mistakenly as recurrence and therefore leading to an unnecessary treatment, if using PSA as the only trigger.

I wish you the best and hope all goes well in 2011. Have a good New Year.
VGama

ob66
Posts: 214
Joined: Apr 2010

Yes, there was more to it than my 0.02 rise in PSA. My pre daVinci numbers were Gleason 7, post surgery Gleason 8. I have a Stage T3b nomx (no metatstatic) number to boot. The rise was after 10 months, and I do feel that my MD was possibly being overly careful for I am a fellow medical practitioner (the this can't happen to my buddies syndrome). In addition, I was not unwilling, for when first diagnosed with PCa I was all for "getting the CA out of me" and opted unwaveringly for surgery. I have followed with RT and had an AUS so you can see that I am a pretty Type A, proactive individual. My mindset is much better when I am doing something about my own destiny. In addtion I have gone on a no red meat, no dairy, and minimal sugar diet, along with exercise which I have been doing for 35 years (Aerobic and weight lifting, plus walking, cycling, etc.).
Similarly wishing you a happy new year and all the best in 2011. Bob

ps. And again, if anyone has a good source of current ultrasensitive PSA readings, I would appreciate it.

will1946
Posts: 10
Joined: Dec 2010

...for your comments, but don't let this stop anyone else from weighing in. Happy new year and good luck to all of you.
Will

VascodaGama's picture
VascodaGama
Posts: 1515
Joined: Nov 2010

Bob
Thanks for clarifying your case. Your objectivity is a good example for the many “Newbies” reading our posts that come here frighten of their PCa case. Ambiguity could lead them to confusion. My posts sometimes may hurt fellows in our wagon (no bad intent) because I do not choose the way of “sorry” but I like to confront any problem of PCa, firmly and with solid information even if I, as laymen, make wrong judgments sometimes.

You may discuss about ultrasensitive PSA readings with Tony Crispino (http://www.caringbridge.org/visit/tonycrispino). I read that he has tested his PSA every day during one month and surprised most of us with a variety of results. It seems that Thursdays PSAs were the highest but all different.

I hope his site helps in your quest.
A Good 2011
VGama

FreddyJoe
Posts: 42
Joined: Dec 2010

I found out my PSA was high by accident,my Dr retired and the new one ran a bunch of test. I had a biopsy a while later and started treatment about 1 1/2 years ago. A man I worked with had what his Dr called high PSA scores, he had biopsy done twice and nothing was found. There does seem to be a varaition in who does the testing.

I am new to this Forum, I just found it today. I have looked at a few of the threads and saw nothing on the treatment I had. My Dr called it GPS for the body, little seed like things are implanted in the prostate to guide the radiation machine like a GPS.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

FreddyJoe,

Welcome to the forum. Can you tell us what kind of radiation treatment you received? Tomography, CyberKnife, IGRT?

FreddyJoe
Posts: 42
Joined: Dec 2010

They call it GPS for the Body see www.calypsomedical.com. They implant 3 small beacon transponders in the prostate to guide the machine. They make a mold of the legs and put 3 tattoo dots on the body so we are always in the same position. If anything in the body moves, the machine senses it and the table shifts. It was quick and painless, I just left work about an hour early each day and laid on the table for 15 or 20 min. I would stop and go fishing on the way home, as I recall I had 44 treatments.
I did not know much about this at the time, and still do not. I never heard of the DaVinci
and just recently learned of a Cyber Knife. They did the bone scans and stuff and found the say it was confined to 1/2 of the prostate only. I do not even know what my gleason score was, but I do remember that the PSA was 20 and now down to zero with the hormone shots. I had no clue that I had a problem until they did blood work and found the PSA high. I am some what concerned about the hormone therapy, I heard the FDA has put warnings on some.

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