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Should I be concerned....

WCavinSC
Posts: 2
Joined: Aug 2018

RRP in August 2005 by Alan Partin at Johns Hopkins.  4+3 Gleason, T2b with no spread. PSA undetectable for 13 years since RRP, using same lab each time. 

However, in Fen 2018, PSA registered <.04 so local urologist in SC wanted to retake again in 6 months. Test was earlier this week and now it registers <.05.  

 I realize <.05 is normally insignificant, but with undetectable levels for 13 years, no prostate to Produce PSA, and all of the sudden it registers twice in 6 months ...should I be concerned?

thanks for taking time to respond.  

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Cavin,

The terminology used along the 13 years, in fact represented a value that you were never informed of. Usually the "Undetectable" level is registered by laboratories representing any value below 0.1 ng/ml. The sign "<0.04" and "<0.05" would be within the same parameters. Each laboratory got standards to set what to write in their reports. This is done by the specialist in charge. In such low levels even an equipment noise would provide a 0.01 difference.

I think that you need more increasing results to really be concerned. Biochemical failure are usually values above 0.05, that represents remission. Recurrence is usually declared when the PSA increases continuously (periodical tests) and reached the threshold of PSA=0.2 ng/ml.

Best,

VG

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

Calvin, my own results history matches what Vasco said exactly. 

My first two years following DaVinci, my PSAs always showed some numbers to the right of the decimal. These floated around seemingly at random, but they were always dubbed "Undetectable."   The same lab has since stopped showing any numeric reults to patients, but my results sheet still always says "Undetectable."  (My results have always been drawn and developed in the urologist's office while I wated for an appointment. Same machine, same techs. But they altered the results sheet.)

"Undetectable" in PSA testing has never meant absolute zero, anywhere.  It would be better for patients if no numbers below what is considered by a lab to constitue "Detectability" were shown to the patient. It would eliminate a lot of anxiety and worry.

A Wendy's Chicken commercial used to spoof what goes into chicken nuggests. A cashier told a customer asking what parts of the chicken go into nuggets with "Chicken parts. And parts is parts."

Similiarly, Undetectable is undetectable.  We probably don't want to know more.

max

Clevelandguy
Posts: 427
Joined: Jun 2015

Hi WC,

Was the test 13 years ago and the test today done by the same lab?  You might have been in the .01-.04 category around 2005 but that lab considered it undetectable.  In another lab they might be reporting the .04 as the reading and not "undetectable".  My point is they might both be the same numerical reading but called different things by different labs in different states.    + or - .01 point could be lab sampling method variation from .04 to .05

Dave 3+4

Old Salt
Posts: 720
Joined: Aug 2014

No need to be concerned; all four of us agree.

WCavinSC
Posts: 2
Joined: Aug 2018

Thanks for all the informative answers -- really appreciate y'all taking the time to consider my questions.  Your responses have confirmed what I was thinking -- not to be concerned -- but I do want to provide just a little more info to see if you still feel the same....

1)  All 13 years of testing have been through the same lab and my local urologist is the same.

2) In those 13 years, I have gotten actual scores of the tests, not just "undetectable".  The scores were always <.02 and at least twice was <.01, until the Feb 2018 test came back <.04 and the Aug test <.05.

I should have mentioned a couple of details from 2005 that might play into the equation also:  

  1. I was 37 years old when diagnosed and had the RRP at Hopkins.  Family history -- Dad was 56 when diagnosed in 1991, Brother was 43 when diagnosed in 2009, uncles (Dad brothers) were in there 60'2 when diagnosed in the 80's and 90's.
  2. When I was diagnosed, my PSA was a whopping <.07.  Yes, you read that right....POINT ZERO SEVEN.  I had no symptoms but asked my family doc during my annual physical (because of family history and a gut feeling) to do the PSA test and DRE.  PSA was of no concern, but the prostate had a hard nodule on it.  He referred me to the urologist I've been seeing since and after a confirmation PSA (that also registered <.07) and another DRE (lucky me!), a biopsy was performed which found 5 of 12 cores to have PCa.  Being so young, I chose to go to one of the best in the world (Alan Partin of the Partin Tables) to have my surgery.  I visited MD Anderson (where my Dad had radiation) and the Mayo Clinic as well.  Initially 3+3, but increased (as many do) to 3+4 post surgery.  Negative margins.

Regardless of whether this is something to be concerned about, even worst case it's probably slow-growing or stagnant.  The only reason I'm asking the questions, is that for a PCa survivor I'm still a young fella...having just turned 51 in the last few weeks.  So, I have a long life ahead of me (God-willing) and can't wait until after my follow-up with the urologist on Sept 7th when he tells me I've got nothing to worry about.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

The Diagnostic Criteria are what they are. I would say that your PSA at diagnosis is irrelevant for confirmation of recurrance. 

It was also mentioned above that definitionally Undetectable numbers drift around and are irrelevant if under Undetectable levels, and also that some labs used to post the numbers, but no longer do.  Most likely, doctors got tired of patients panicing over clinically undetectable results.

max

 

Grinder
Posts: 438
Joined: Mar 2017

If you take the threshold for alarm as PSA score of .2 and the threshold for treatment at .4 ng/ml (these are the numbers de Gama has mentioned, and are backed up where I have looked) then if you think about it .05 is five one-hundredths ng/ml while the threshold for treament is .4 which is four tenths nanograms per ml. Thats a helluva lot more than five hundredths.

And, .05 is only two and a half times .02... but .4 is twenty times .02. You have a looooong way to go before you have go start worrying about treatment for recurrent PC.

When we're talking nanograms per millilitre, at five hundredths, the quantities are so minute they are considered undetectable. No one that I know of has gotten a PSA score of .00. Maybe someone has but I don't know of any.

So relax, you have a long way to go before you ever have to worry, and quite likely, never have to worry.

Grinder
Posts: 438
Joined: Mar 2017

.02+.02=.04

.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02+.02=.4

That is visually the difference between your current rate of increase and the rate of increase before treatment is recommended.

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

It bears watching. I have had several "PSA returning" experiences over a period of 27 years. Not complaining, I am happy to be here. See my entry on this discussion board dated April 18, 2018 entitled "Old-timers PC Experiences, April 18, 2018."

Good luck to you.

Old-timer (Jerry)

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Cavin,

From your added information about the family PCa history and your own experience in having several low PSA results in spite of a positive diagnosis (5/12 contaminated cores) and latter a confirmed Gleason score 7 (post RP), it makes me think that your cancer was made up of cells that produced little or no PSA serum at all (a gland made up of uncommon epithelial cells or cells so much deformed like Gr5 that cannot function normally to produce the common levels of serum). These cases are rare but exist. It seems to be more common among guys with fertility issues.
Unfortunately it seems that you are one of those that should not rely on the PSA alone to access due development or judge progression of the disease. Most of the doctors in this group of people use the symptoms to evaluate the situation. I believe that even Dr. Partin would have a hard time to evaluate the results of his operation now past 13 years of the D day.

A fewer number of epithelial cells at the urethra also produce tiny volumes of PSA serum and these could be the ones representing the present low readings. Surely you need to be attentive on any possible recurrence but using a blood sample (the PSA) alone to evaluate your status may be like playing Russian roulette. You are also young so less prune to arising symptoms typical in recurrences of PCa (urination issues, abdominal pain, constipation, hematuria or rectal bleeding, bone deterioration, etc). If I was you I would get periodically several other tests and exams (image exams) to chack issues that could exist due to the effects of a grown PCa tumor. After all even if we had received a clean pathological report (negative margins or none extraprostatic extensions) these data could be erroneously reported because pathologists do not analyze the whole dissected gland (100%). The specimen is stained but only the common regions of the gland are put under the microscope.
I wonder how much Gleason rate 4 was found and the estimated total volume of cancer reported by the pathologist post RP. That could change the way one thinks about your case.

Best wishes for peace of mind.

VGama

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