Psa

JOHNJR515

my name is John I am 66 on january 4 I had robotic prostate removed with a Gleason 6 over past for half years my psa numbers have been 0.06   0.01. 0.08  0.01. 0.08up down no higher so far then 0.08 done at va hospital my dr of last 5 years retired who never was concerned with numbers but my new person is nurse practitioner telling me numbers are bad you intake would mean a lot I am having no problems at all haven't even met this new practitioner yet except phone

VascodaGama

PSA thresholds

Hi John, 

The story you presented in this thread is different from the story you posted in another thread. Please clarify which one is valid. In any case, the low values of the PSA you tested along the months post RP are considered normal but some doctors use low PSA threshold markers  to indicate biochemical failure. I wonder the threshold levels used at your hospital/clinic that lead the nurse to tell that they are bad.

The fluctuations in such low ranges ( 0.0X ng/ml) could be due to equipment noise or tiny levels of the stuff produced by cells of other organs showing variations along the 24hours. In fact, doing the test from blood in the morning and repeating it from blood drawn in the afternoon will present different results. 

For such reasons the traditional testing schedule that permits judging recurrence post RP is typically obtained at three weeks, two months and then every three months. The level indicating Biochemical Failure varies from doctor to doctor but it spans between 0.05 to 0.10 ng/ml. Recurrence is declared when this reaches a level above 0.20 ng/ml. Intervention with a salvage therapy is recommended when the PSA reaches above 0.40 ng/ml.

In your shoes I would wait for the next test in three months and then visit the doctor if it becomes higher than 0.10.

PSA causes us anxiety.

Best,

VGama 

 

JOHNJR515

VascodaGama said:

PSA thresholds

Hi John, 

The story you presented in this thread is different from the story you posted in another thread. Please clarify which one is valid. In any case, the low values of the PSA you tested along the months post RP are considered normal but some doctors use low PSA threshold markers  to indicate biochemical failure. I wonder the threshold levels used at your hospital/clinic that lead the nurse to tell that they are bad.

The fluctuations in such low ranges ( 0.0X ng/ml) could be due to equipment noise or tiny levels of the stuff produced by cells of other organs showing variations along the 24hours. In fact, doing the test from blood in the morning and repeating it from blood drawn in the afternoon will present different results. 

For such reasons the traditional testing schedule that permits judging recurrence post RP is typically obtained at three weeks, two months and then every three months. The level indicating Biochemical Failure varies from doctor to doctor but it spans between 0.05 to 0.10 ng/ml. Recurrence is declared when this reaches a level above 0.20 ng/ml. Intervention with a salvage therapy is recommended when the PSA reaches above 0.40 ng/ml.

In your shoes I would wait for the next test in three months and then visit the doctor if it becomes higher than 0.10.

PSA causes us anxiety.

Best,

VGama 

 

numbers

hi vgama, i guess i was not to clearon the last posts as the new young practitioner is driving me crazy but i have my notes in front me be more clear  my biopsy showed small trace cancer gleason 6 surgery in jan 2017 3 weeks after surgey psa was 0.08  then 2 months later it was 0.06 then 5 months out it was 0.06  then one year was 0.06  then year half 0.08  then two years out ot was 0.01   2 half years was 0.06    three years 0.01   four yrs 0.01   last 0.08 as i said in my previous posts this new practitioner is really pushy at the va where as my old dr that retired said lets just watch the numbers was not overly concerened but this practitioner is unreal. I hope i have been more clear in this post also my psa before surgery was 3.7 when i was 62 i am now 66 your thoughts one last time whould be greatly apprreciated.   john

VascodaGama

A constant upward trend is for concern

Hi John, 

Please note that I am not a doctor. My opinions are based on my 20 years of research and experiences gained as a survivor from our common  disease. 

Regarding your request, I think that the nurse's comment has no valid basis. PSA fluctuations are common in such low levels and not indicative of recurrence. The increase of the PSA from 0.01 to 0.08 may raise alarms but it seems to fit your PSA histology since 2017. Most probably it may decline again in your next test.

As I commented above, the PSA level varies due to several reasons which makes it obligatory to draw conclusions not only from the value but on the trend it shows along the years. I believe that your previous doctor had this same principle. Constant increases is what defines an aggressive behavior. 

Gleason 6 cases are typically none aggressive, however, voluminous cases of G6 (cancer occupying more than an half of the gland) seem to have worsen outcomes. If curious you can look for any particular opinion describe in the pathologist's report retrieved from the analysis on the dissected gland. In fact this report is more important than the biopsy findings because they check all evident particulars in the whole gland. Sometimes those diagnosed initially with Gleason 9 may drop to Gleason 7 or guys with Gleason 6 may increase to Gleason 7.

Surely no one can say that one doesn't recur. But at least we know that there will be salvage therapies in case of necessity.

Wait for the next test and visit the doctor if you see it increasing above 0.10.

Thanks for the update. 

Best wishes,

VGama 

JOHNJR515

VascodaGama said:

A constant upward trend is for concern

Hi John, 

Please note that I am not a doctor. My opinions are based on my 20 years of research and experiences gained as a survivor from our common  disease. 

Regarding your request, I think that the nurse's comment has no valid basis. PSA fluctuations are common in such low levels and not indicative of recurrence. The increase of the PSA from 0.01 to 0.08 may raise alarms but it seems to fit your PSA histology since 2017. Most probably it may decline again in your next test.

As I commented above, the PSA level varies due to several reasons which makes it obligatory to draw conclusions not only from the value but on the trend it shows along the years. I believe that your previous doctor had this same principle. Constant increases is what defines an aggressive behavior. 

Gleason 6 cases are typically none aggressive, however, voluminous cases of G6 (cancer occupying more than an half of the gland) seem to have worsen outcomes. If curious you can look for any particular opinion describe in the pathologist's report retrieved from the analysis on the dissected gland. In fact this report is more important than the biopsy findings because they check all evident particulars in the whole gland. Sometimes those diagnosed initially with Gleason 9 may drop to Gleason 7 or guys with Gleason 6 may increase to Gleason 7.

Surely no one can say that one doesn't recur. But at least we know that there will be salvage therapies in case of necessity.

Wait for the next test and visit the doctor if you see it increasing above 0.10.

Thanks for the update. 

Best wishes,

VGama 

numbers

thank you so much for your intake it has helped me a lot the nurse prac that informed me of all this was very unprofessional all on the phone whom i have never met even the veterans hospital has been very good to me but this new urology  person just gave me bad vibs again thank you   john

Georges Calvez

Hi John,

If I were in your shoes I would ask for a retest and see how that comes out.


Best wishes,

Georges