PSA Testing | Rising, concern?

LookingForAnswers12

hi there board members. I wanted to just quickly pop on here and hopefully get some news and or recommendations. we all know how hard it is when your mind is constantly racing and looking for answers and even harder when its a loved one. I've been on this board before but can not seem to remember my username and nor password that I used when I first registered.

long story short - father had davinci surgery and followed it up aggressively with radiation 5.5 years ago. results have been great, operation was five years ago. consistently receives psa testing every 6 months in manila, over the past 5 years. however, due to the covid pandemic, and the danger of traveling in the open, he decided to get a psa test locally, in the province.
he has had consistent test results of 0.05, 0.08. etc.. however, his test results at the new clinic yesterday popped a 0.10. In manila, they definitely use ultra sensitive and I don't know if this new place does or not. I know I am leaving a lot of information that I should probably ask and research, but from everyones experience, how concerned should I be with that 0.10 reading?

(sigh) Hoping everyone on this board is doing well and battling through this! Appreciate you all!

VascodaGama

We could consider still Remission

Hi Filipino,

I could not understand well your question. Are you concerned with the increase of the PSA (0.05 to 0.08 to 0.10 ....) or is that you are suspicious of the last test result for being done at a local laboratory. Surely the results done at different laboratories can give different results. Apart from that some assays have higher or lower limit of detection (LLD) which in the case of the last result of 0.10, could mean that the value would be anything lower than 0.10 ng/ml. Usually laboratories represent their assay's LLD with the sign "<" before the value (<0.10 ng/ml).

You can check the above, in any case, the last PSA is classified as remission by many oncologists that use the threshold PSA=0.1 in a guy that had the combination treatment of RP plus RT. Five years in remission may be the right way of thinking. However, the constant increase could also mean biochemical failure signifying that your dad will need further intervention in the future. In your shoes I would ask him to continue vigilance with periodical PSA tests. Usually the concern starts when the PSA shows constant increases three times after nadir (your dad's nadir was 0.05 and the following increases are only two: 0.08 and 0.1), and also when the PSAdt (doubling time) is lower than 9.5 months.  

The typical treatment after RP+RT failure is hormonal (ADT). This is done with agonists injections and/or antiandrogens pills, but depending on the patient's age, other health issues or situation in terms of access to hospitals (some provinces in the Philippines are really remote), it can be done with orchiectomy (permanent castration). ADT works at any level of the PSA meaning that your dad can follow vigilance for a period according to the instructions of his doctor. Asymptomatic patients in good health and well fit manage to wait till their PSA reaches a threshold higher than 5.0 ng/ml to start the treatment. Older patients may wait further till their PSA reaches 10.0 ng/ml. Your dad's is at very low (<0.1) levels.

During a period of my PCa case I used the laboratories of Makati med and St Luke's medical center when on assignment to the Philippines.

Magandang araw.

 VGama

Clevelandguy

More tests

Hi,

If it was me I would get a couple more PSA tests to see if he is getting an upward trend.  An upward trend could indicate re-occurance. Last time I heard the number for re-occrance is a PSA above .2.  Like Vasco said it could be a difference in labs.

Dave 3+4

LookingForAnswers12

VascodaGama said:

We could consider still Remission

Hi Filipino,

I could not understand well your question. Are you concerned with the increase of the PSA (0.05 to 0.08 to 0.10 ....) or is that you are suspicious of the last test result for being done at a local laboratory. Surely the results done at different laboratories can give different results. Apart from that some assays have higher or lower limit of detection (LLD) which in the case of the last result of 0.10, could mean that the value would be anything lower than 0.10 ng/ml. Usually laboratories represent their assay's LLD with the sign "<" before the value (<0.10 ng/ml).

You can check the above, in any case, the last PSA is classified as remission by many oncologists that use the threshold PSA=0.1 in a guy that had the combination treatment of RP plus RT. Five years in remission may be the right way of thinking. However, the constant increase could also mean biochemical failure signifying that your dad will need further intervention in the future. In your shoes I would ask him to continue vigilance with periodical PSA tests. Usually the concern starts when the PSA shows constant increases three times after nadir (your dad's nadir was 0.05 and the following increases are only two: 0.08 and 0.1), and also when the PSAdt (doubling time) is lower than 9.5 months.  

The typical treatment after RP+RT failure is hormonal (ADT). This is done with agonists injections and/or antiandrogens pills, but depending on the patient's age, other health issues or situation in terms of access to hospitals (some provinces in the Philippines are really remote), it can be done with orchiectomy (permanent castration). ADT works at any level of the PSA meaning that your dad can follow vigilance for a period according to the instructions of his doctor. Asymptomatic patients in good health and well fit manage to wait till their PSA reaches a threshold higher than 5.0 ng/ml to start the treatment. Older patients may wait further till their PSA reaches 10.0 ng/ml. Your dad's is at very low (<0.1) levels.

During a period of my PCa case I used the laboratories of Makati med and St Luke's medical center when on assignment to the Philippines.

Magandang araw.

 VGama

I thank you so much for the

I thank you so much for the detailed reply. I too have a feeling that this new place that he went to (which was a little clinic) might have caused our fear of the numbers going up. I am aware of St. Lukes in Taguig! That hospital is amazing and the staff excellent. He had both his surgery and radiation treatment there. We are big fans of that place. 

We have always gone there for his PSA tests, but as mentioned, with Covid, travelling these days is not as easy due to lockdowns and quarantine orders. I am trying to think of the results, theyve always been 0.02, 0.05. 0.02. 0.05, and this is the first time where it registered a 0.1. I do know that St. Lukes uses ultra sensitive testing, Im not quite sure about the clinic. 

Again I am going off of memory and I do apologize for not having all the information immediately in front of me, but I beleive his gleason score was a 7. He is super healthy, excersizes frequently, walks, runs, does not drink, does not smoke. He does use pads, but has no problem controlling his urine, etc... 

It's never easy hearing of a spike and I am hoping that the spike was due to the lab switch. He is 67 years old and as mentioned, in great shape. 

Max Former Hodgkins Stage 3

Clevelandguy said:

More tests

Hi,

If it was me I would get a couple more PSA tests to see if he is getting an upward trend.  An upward trend could indicate re-occurance. Last time I heard the number for re-occrance is a PSA above .2.  Like Vasco said it could be a difference in labs.

Dave 3+4

Ditto with Cleveland

Looking,

My understanding in the US is that most doctors accept the definition of recurrrence as  00.20   Protocols and standards differ slightly between nations.

"Cure" or NED ("no Evidence of Disease") is regarded as any number below 00.20.    Even with non-ultra-sensitive PSA tests, the fractional number is never the same between any two samplings;  it drifts around each time.  My results over the last five years have never had the same number twice, for instance, but clinically, these are always reported as "Undetectable."  While "Undetectable" would SEEM to imply 00.000, it does not, and I do not believe any individual can get an accurate result of 00.000, including when they are told by their doctor that is was 'undetectable.'

I would recommend that he go back to the non-ultra-sensitive testing when possible, and in the same lab that he had been using, so as to be comparing apples-to-apples.    At this point you have no real basis for fear, but do follow this closely.  And ask his doctor what their numerical definition of relapse is.

Racer7746

PSA Testing

My PSA tests have never been above 2. My doctors say I am the odd one.  Had alot of trouble peeing, useing the restroom alot.  Had many PSA tests done.. Had surgery called TURP.  It saved my life.  They found tissue I will call it, did biopsy and more testing, stage 4 Prostate Cancer.  This was back in end of 2016. 6 plus hrs of surgery with the Da Vinci system  I have been good since.  I have to wear depends for the rest of my life, but they are looking into AMS Urinary Control System AMS 800 for me now.  I go back to my Urologist every 6 months now.. SO FAR SO GOOD.  But he does not relie on the PSA test for me to much. I guess my mother was right, when she I was special.  Just a little info I would like to share.  I am 58 now..