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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2005Statistics
My last three PSA tests have come out (less than) <0.1; <0.1; <0.1. My Dr said that <0.1 is as low as they can test. In this group I see postings saying their PSA is <0.01. Is my Dr's statement wrong or the posted stats off by a point? Biff Biff...Your doc's statement is wrong. Ultrasensitive PSA tests, which have been routinely available for years, measure down to the 0.002-3 ng/ml range. Often the results are rounded by the reporting institution to read as <0.01 ng/ml...Best wishes and good health, Ron > My last three PSA tests have come out (less than) <0.1; <0.1; <0.1. > My Dr said that <0.1 is as low as they can test. [quoted text clipped - 4 lines] > > Biff On May 23, ron responded to Biff's question: > Biff...Your doc's statement is wrong. Ultrasensitive PSA tests, which > have been routinely available for years, measure down to the 0.002-3 > ng/ml range. Often the results are rounded by the reporting > institution to read as <0.01 ng/ml...Best wishes and good health, Ron Agreed. The test is performed using the "DPC, Third Generation, ICMA" method. Test code number is 11061. The name of the test is "PSA, Post-Prostatectomy." It is useful even where the patient may have had some other primary tx. Regards, Steve J >>My last three PSA tests have come out (less than) <0.1; <0.1; <0.1. >>My Dr said that <0.1 is as low as they can test. [quoted text clipped - 4 lines] >> >>Biff > Biff...Your doc's statement is wrong. Ultrasensitive PSA tests, which > have been routinely available for years, measure down to the 0.002-3 [quoted text clipped - 3 lines] >>My last three PSA tests have come out (less than) <0.1; <0.1; <0.1. >>My Dr said that <0.1 is as low as they can test. Perhaps the doctor meant that .1 is as low as is useful to test for. There is some difference of opinion among urologists about whether or not it makes sense to use ultrasensitive PSA tests following surgery. Reasonabel arguments can be made for either side of the dispute. >>In this group I see postings saying their PSA is <0.01. >> >>Is my Dr's statement wrong or the posted stats off by a point? >> >>Biff <0.1 is as low as that particular testing equipment can detect. Congratulations!  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > My last three PSA tests have come out (less than) <0.1; <0.1; <0.1. > My Dr said that <0.1 is as low as they can test. [quoted text clipped - 4 lines] > > Biff > <0.1 is as low as that particular testing equipment can detect. > Congratulations! That's what I thought too. The value of ultrasensitive testing and readings below <0.1 has been debated on this group several times that I know of. I can see why such readings would be of value to Steve, but for a post-surgical patient who had clear margins, ultrasensitive testing can be a cause of unnecessary worry. <0.1 is good enough for my uro and GP at Johns Hopkins, so it's fine with me. jimhoney standard RRP age 52, cured, no significant aftereffects > ... > The value of ultrasensitive testing and readings below <0.1 [quoted text clipped - 3 lines] > ultrasensitive testing can be a cause of unnecessary worry. > ... At the National Cancer Institute, their Radiation Oncology Department reports <0.2 as their minimum reading. I don't know what tests they're using, but they think that for radiation patients there's no significance to any difference between readings below 0.2. For surgery patients, .2 is probably too high a threshold for reporting, but .1 doesn't sound unreasonable. If your reading were .03 and it went up to .04, or maybe even .09 on the next test, that might be cause for alarm, but probably wouldn't yet be a justification for additional treatment. So there'd be nothing to do with the alarm but stew on it. At any rate, that's my non-expert view of the matter. Alan My Uro can read to two decimal places - my post LRP was .24. However he has a strong opinion that at very low PSA reading it's a real question as to whether you're getting real PSA readings. In his opinion there are other constituents that can, to some small extent, mimic the reaction used for PSA. He says that any reading below .1 should be used qualitatively not quantitatively. A shift say from.04 to .07 might indicate closer scrutiny but should not be cause for action. In my case it's all academic and I'm off to radiation next week. "My Dr said that <0.1 is as low as they can test." It depends on who the "they" is. Some uros just refuse to go w/ the ultrasensitive test. When I demanded of my previous uro that they use the ultrasensitive test I was told by his underlings that the lab they use (Dianon) did not offer it. Total B.S. I for one do not like being lied to by my medical providers. The standard test may be fine for you but the fact remains that they are B.S.ing you. Bill Denton RP 2/12/02 PSA .45 Memphis Hi to all. At the 5 week mark...after open surgery, they did a blood draw and I was told that my PSA was 'undetectable' and another doc called for me and they told him 'undetectable' at 0.0 I never heard of a 0.0 so... I see Dr. Catalona at Northwestern Memorial in Chicago and have read in the group and the literature about "sensitive' tests. So I asked Dr. Catalona about these .03 readngs and <0.1 etc. and he said that he uses Beckman Coulter tests and that's what he likes. Even if there are detailed explanations of this...I just HAVE to go with what the doc goes with. If HE feels it's OK..."I" have to feel it's OK. I was such a basket case since diagnosis (and I thank you all again for your support) that I can't do much more. I gotta 'dance with the doc that carved me' .. :-) Ron B. Chicago > Hi to all. > [quoted text clipped - 19 lines] > > I gotta 'dance with the doc that carved me' Remember that he has done a significant part of the important research on PSA and prostate cancer. So you can't do much worse than relying on him in such matters. > .. :-) > > Ron B. > > Chicago Ron B, I asked my docs about the ultrasenitive test, and they said it may identify a recurrence earlier slightly, but that there is no evidence that earlier salvage treatment is beneficial. It does seem to drive guys crazy, so I have chosen to stick with the standard one. Steve U > Ron B, > I asked my docs about the ultrasenitive test, and they said it may > identify a recurrence earlier slightly, Sensitive Prostate Specific Antigen measurements identify men with long disease-free intervals and differentiate aggressive from indolent cancer recurrences within 2 years after radical prostatectomy; Witherspoon LR, Lapeyrolerie T, J. Urol. 157:1322-1328, 1997 This is the oft quoted reference on this subject. Using the DPC Immulite 3rd Generation assay (PSA detection limit 0.01 ng/ml), the authors found that of those RP patients with rising PSA, 100% were identified by 30 months post-RP using the ultrasensitive test. Only 50% would have been identified by 24 months with the non-ultrasensitive test (PSA detection limit 0.10 ng/ml). In addition to earlier identification of failures (and hence more time to plan and still treat at a lower PSA level), the ultrasensitive test has prognostic value. Post-RP men who nadir <0.01 ng/ml have better outcomes than those who do not. > but that there is no evidence > that earlier salvage treatment is beneficial. Wow! There are literally too many references on this point and they all agree that for RP or RT failures, earlier treatment at lower PSA levels leads to better outcomes. Search PubMed...Best wishes and good health, Ron > It does seem to drive > guys crazy, so I have chosen to stick with the standard one. > Steve U "ron" <oitbso@yahoo.com> wrote iom... >> but that there is no evidence >> that earlier salvage treatment is beneficial. > > Wow! There are literally too many references on this point and they > all agree that for RP or RT failures, earlier treatment at lower PSA > levels leads to better outcomes I assume that refers to salvage RADIATION, and not ADT? I.P. ADT too, there are a number of studies on high-risk men that show men who have treatment (RP or RT) and adjuvant ADT do better (survival, disease-free survival) than men in the treatment only arm of the study (for example the work of Bolla or Messing or Granfors). Other studies (Brooks or Moul) show that early ADT is better than late ADT after failed RP. If I recall correctly, these studies are relatively short-term (~ 5 years out), so the advantage is seen only with high-risk men. The question remains, as the studies move further out in time will an advantage for men in lower risk groups begin to appear...Ron > ADT too, there are a number of studies on high-risk men that show men > who have treatment (RP or RT) and adjuvant ADT do better (survival, [quoted text clipped - 6 lines] > in time will an advantage for men in lower risk groups begin to > appear Because my case was quite high-risk and both my QOL and my grim 5-yr and laughable 10-yr prognoses depend strongly on it, I researched adjuvant ADT for hundreds of hours, including all those references, I think, plus many more. I found very little prognosis benefit (roughly 7 months, on averag, at the end of many years, and without regard to QOL) for ADT prior to the development of symptoms after initial treatment. It's also my understanding that "early" means immediately post-treatment, with PSA still essentially zero, so any adjuvant treatment after RP failure is, by definition, late rather than early. Walsh, Strum, and several others come right out and say in several ways that ADT prior to recurrence symptoms is not supported by evidence, especially considering the SEs. A team of university oncologists validated my research. This was three months ago; if you've seen newer evidence to the contrary, my life insurance company and I would sure appreciate a link to it. I didn't refuse ADT because of its SEs; I refused it while asymptomatic because there's no evidence it helps much, may even lead to quicker and/or worse recurrence, AND has SEs. i.e., the benefit to risk ratio didn't float my boat. I.P. As I mentioned earlier, significant differences show up primarily in high-risk men. Studies that don't stratify their results by risk group may only see small differences in the overall population. The study by Brooks, et. al. (International Journal of Radiation Oncology*Biology*Physics, Volume 59, Issue 2 , 1 June 2004, Pages 341-347, Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes?) reports, "for pGS 8 the 5-year bNED rates were 65% for combined therapy and 17% for RT alone (p = 0.075)" and "the 5-year OS for pGS 8 was 100% for combined therapy and 54% for RT alone (p = 0.04)". I would have thought that these statistics would have translated into more than a few months difference, but I don't know that...Ron Could you provide a link, please? I'm having no luck Googling it. Or is this, as it sounds, applicable specifically and only to combined RT/ADT after failed RP? I.P. > The study by > Brooks, et. al. (International Journal of Radiation [quoted text clipped - 6 lines] > statistics would have translated into more than a few months > difference, but I don't know that...Ron If you search the title ("Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes") at PubMed http://www.ncbi.nih.gov/entrez/query.fcgi you will get the abstract. This article was for RT/HT post-RP failure. Some of the other references I gave in the earlier post were for HT alone post-RP or -RT failure...Ron Ahhhh, that helps. Thanks. I'll file it for future reference if and when I need to consider RT. I REALLY need to keep reading this stuff so it starts to make sense intuitively. As it is, I read and re-read and re-read the RESULTS sections, trying to make useful sense of the jargon and phraseology. It's particularly hard to get excited about a mere 10-20% increase in improvement considering the downsides of ADT, and trying to apply statistics like this to non-RT-related scenarios would a) require a far better understanding of oncology than I have, b) be invalid scientifically, and c) lead to many incorrect assumptions (such as the broad hypothesis that antioxidants are magic and CAB is better than monotherapy). I.P. > If you search the title ("Radiotherapy after radical prostatectomy: > does transient androgen suppression improve outcomes") at PubMed [quoted text clipped - 4 lines] > Some of the other references I gave in the earlier post were for HT > alone post-RP or -RT failure...Ron
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