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PSA Test Results

TonyT
Posts: 5
Joined: Dec 2013

I am a 73 year old man who had a diagnosis of prostate cancer in April, 2012 (Gleason score 7, one positive of 12 biopsies).  I had radical prostatectomy, and the pathology report indicated the cancer was confined to the prostate with no evidence of any spreading.  The path report did say that there was "perineural" involvement. Four months after the surgery, I had a PSA done at a commercial laboratory with a result of 0.2.  The surgeon said it should have been undetectable and ordered the test repeated at his hospital lab.  This result returned at 0.34.  The conclusion was that I should have radiation to the prostate bed.  I had IMRT starting in July, 2013, and the 3 month post radiation PSA done at the same commercial lab that gave the initial result was again 0.2.  The radiation oncologist was pleased that the result dropped from the 0.34 result obtained in January, 2013.  I was hoping for an undetectable result.  I had wanted the radiation oncologist to order a baseline PSA prior to the radiation treatments, but he said it wasn,t necessary.  My concern is that the 0.2 and 0.34 results were from different labs.  I had read that the same lab should be used to follow PSA changes.  Does anyone have any thoughs on this?

VascodaGama's picture
VascodaGama
Posts: 1535
Joined: Nov 2010

Hi Tony

Welcome to the board.

I read your comment about PSA tests in another thread and I believe that you as a professional analytical chemist know better than us that PSA results may be erroneous at tiny fractions, so that a simple test should not be used to draw a decision.
In your last results of 0.2 (ng/ml) I think that, a part from any possible error from the different assays in different laboratories, you should consider the fact of probable causes (eg: inflammation), that are typical and influence the procedures.

I do not know why you are inquiring about your results or about their meaning. However this simple result in your case is still insignificant to declare failure or success of your treatment. You have no prostate in place but the urethra also produces (insignificant) tiny portions of serum PSA that can take time to “clean up” from our system. Do not let the similarities in the results to perplex your thoughts or scare you up. Continue the periodical tests and wait for the results to judge your case.

In my experience of radiation treatment after surgical failure, the PSA come down gradually taking 14 months to reach nadir. It was 3.8 at the start of RT, then it come at 2.26 at the end of RT, then 0.52 two months after, and reached to a nadir of 0.05 ten months after. Unfortunately, it did not stay there and recurrence become apparent and declared on the third consecutive increase with a “cut-off” nadir of 0.26. This occurred 29 months from the end of RT.

Surely one can expect to get different results from different labs but not huge differences. After a treatment the PSA becomes an important marker to judge outcomes and one should be careful in the choice of a lab to follow up the treatment, giving preferences to reliable places. Ultra sensitive tests with two decimal places (0.XX ng/ml) are also preferred particularly if there is no prostate in place.

Best wishes for a successful outcome.

VGama  Wink

TonyT
Posts: 5
Joined: Dec 2013

Thank you for your prompt response to my question.  You seem to have considerable knowledge of the subject.  I agree that it might be too early to judge the success or failure of the RT.  I had considered the possibility that some normal prostate tissue was left behind during the surgery.  I had a catheter in place for 6 weeks before it could be removed due to leakage at the urethral resection.  The surgeon admitted that it was a difficult procedure in my case but denied the possibility that he left any normal tissue behind.  Who knows?  At any rate, I will take your suggestion and continue with the follow-up testing and hope for the best.  Best wishes for the future.

Swingshiftworker
Posts: 626
Joined: Mar 2010

FWIW, I do not think it is possible for you to ever achieve an "undetectable" PSA results following IMRT or any other RT.  You can achieve a result less than .01 (which is essentially undetectable) after surgery because the prostate has been removed and thereby entirely eliminated the source of PSA from your body.  Not so for RT. 

IMO, the best you can resaonably expect post-RT is around .3, which you have bettered already with a post-IMRT reading of .2.  So, if I were in your situation, I would not be worried about the earlier pre-IMRT result at .34.

The thing to worry about from here on out is any sustained increase in PSA results in your follow up tests,which may indicate treatment failure. The ASTRO standard for treatment failure is 3 increases in PSA afer nadir (the lowest post-treatment PSA reading) but you are no where near determining your nadir yet. That usually occurs 18 to 24 months following treatment.

So, I suggest that you take a step back, relax and simply monitor your quarterly PSA results from here on out which will determine whether your IMRT treatments over the next 12-18 months which will determine whether your IMRT treatments were ultimately successful or not.

Good luck!!!

 

TonyT
Posts: 5
Joined: Dec 2013

Swingshiftworker and Josephg,

 

Thanks for the info and encouragement.  I admit I was depressed when I learned my PSA did not drop to undetectable after my prostatectomy, but after thinking about it, I decided to try to enjoy my life and not look too far ahead.

Josephg
Posts: 25
Joined: Jan 2013

I agree.

Take this interval of time until your next PSA test to enjoy life and unburden yourself, to the extend possible, from your recent trials and tribulations around PCa treatments.

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