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Sensitive PSA

PawPaw J
Posts: 34
Joined: Jul 2011

Just wanted to check with some members about sensitive PSA. I am 2 1/2 years post open surgery and the first 3 test after surgery my uro did a sensitive PSA. They all came back at <0.03. After that they have been doing normal PSA test where they only go to 0.1. They all have read 0.0. He has said he would not recommend any treatments until 0.1 so they don't do sensative after that. He also said the insurance would not pay for sensitive PSA since they were not necessary. They do the normal PSA test in their office but have to send them to another lab for the sensitive. My concern is that if it would go over 0.03 I think I would want to start thinking about my alternatives and start treatments before it got to 0.1. It seems that most members are getting the sensitive test. My PSA before surgery was only 3.3.  Am I being too cautious or should I push the issue?  

 

VascodaGama's picture
VascodaGama
Posts: 1549
Joined: Nov 2010

Johnny

Nice to hear about your continuing remission. Congratulations.

Regarding the LLD (low level of detection) of assays to test PSA I think that all are valid but in the group of RP survivors the two fractional digits (0.xx ng/ml) is more appropriate when checking-up progression. Guys with no prostate in place (no benign or cancerous prostatic cells) should have lower than 0.05 marks. Any constant and continuous increase above that is significant. You should ask your doctor for his real reason in changing assays. Is it just financial?

Many doctors after a series of low PSA tests in ultra sensitive(s) suggest spanning the follow-up periods to six or twelve months. However, changing from ultra sensitive assays to single fractional digit (0.X ng/ml) in the present PSA-era is for those cases considered “cured” (successful RP), therefore with no need of a “progression follow-up”. The PSA just becomes a routine test as before one has been diagnosed.

Ultra sensitive PSA is known to cause anxiety and you seem to be a “worrisome guy”. Any tinny increase makes us worry and that could just be due to the person biorhythm of that particular day one draws blood or due to assays tolerance (0.002). Surely, a real value of 0.052 (eg; 0.05 + 0.002) in an assay of LLD<=0.1 would be rounded up to 0.06 and that to 0.1, obscuring any progression or recurrence. But even in such a positive case, the “recurrence” status as provided by medical associations is given for cases of confirmed progression above the 0.2 PSA thresholds. This is when they recommend additional treatments.
Probably your doctor decided to consider remission and recurrence in your particular case using the single fractional digit threshold of 0.1. He may be looking into your pathological stage of pT2a pN0 confirmed by the excellent pathological report (post surgery).

Personally I prefer the ultra sensitive. I also prefer to have it tested at bigger modern reliable laboratories. The difference in cost of tests, in single or double decimal assays, in Europe, rounds the bracket of less than US$10. A ultra sensitive costs less than $50. For peace of mind you could do the test by yourself at a laboratory of your choice.

In your previous thread of Jul 2011 you reported about your story. I hope you have recuperated fully and that you are now enjoying life. http://csn.cancer.org/node/225052

Best wishes,

VGama  Smile

hopeful and opt...
Posts: 1310
Joined: Apr 2009

 

Many surgeons do not prescribe  sensitive PSA tests in order to avoid worrying among patients. As Vasco pointed out 0.2 is generally considered the cut off.

You are 2 1/2 years post surgery, with great numbers....

Time to relax and enjoy your life.

PawPaw J
Posts: 34
Joined: Jul 2011

Thanks for the replies. I had sinus surgery and have not been on site. I did ask uro about the test and he said he doesn't recommend salvage treatment until PSA is 0.4 and is still in the group of doctors that go by the 0.2 as recurrance so that is why he does the normal one. I did request the sensitive and it came back @ 0.02, so @ 2 1/2 years post op I am happy. I do seem like the worrisom type but mainly I would just like to know I'm doing what I can to keep up with what is going on. I pay the same price for either test so I just as soon get the sensitive one. Thanks again, Johnny

 

hunter49
Posts: 201
Joined: Oct 2011

I would not put much stock in ultra-sensative tests.  In January this year I went for my 2 year PSA test.  I went to 4 differnt labs and did intra sensative, all on same day.  The findings were .01, <.015, .03 and ,.025.  Needless to say they all have varying ways to measure sensativity.  As long as you do not measure .1 relax and good luck

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