I have been following this newsgroup for several years, but not as
well since being transfered to Houston earlier this year from the NE.
At times I participated, but generally just lurked.  Although I have
seen several short discussions on the value of hypersensitive PSA
testing in the past, this is the first thread that I have noticed that
has posts that indicate that some of you have gone into this subject
as I have in the last few years.

I apologize in advance if I am too long winded or if I offend anyone.
I don't intend to offend, only to share some of what I believe and
hope it makes sense to you all.

For a couple of years after my RP in 1998, my doctor ordered the
standard PSA test from Dianon Labs.  A good, well regarded lab.
During those years I was trying to educate myself about my disease and
learned what I should have known before the surgery.  (I suspect that
most of us did the same after the fact.)  Within my readings, I
learned that there was more than one opinion in the medical community
about PSA testing just as I knew from earlier experiences that much of
medicine is trial and error and some docs are better at it than
others.  This is not an exact science.

Part of my acquired knowledge includes the view that many/most
physicians, like many of us, are conservative in their
professional/business lives and are slow to accept new things/methods.
I have also learned that modern measurement methods/tools in many
scientific and engineering disciplines are providing accurate results
that only a few years ago was unimaginable.

So, why isn't hypersensitive (ultrasensitive) PSA testing accepted as
is the standard method (typically >0.1 ng/ml)?  I found several
medical articles and references that contend that hypersensitive
testing IS accurate and repeatable.  My doctor, although a great
surgeon, followed the standard line and contended that the sensitive
test was not accurate enough to be believed.  His opinion conflicted
with my opinion based on my readings.

Folks, in my opinion we are wrong and possibly hurting ourselves when
we take what a medical professional tells us as gospel, without
questioning, without understanding, on blind faith.  We need our
doctors, but we need to be in control or, at least, participate in a
meaningful way.  Know what is going on, understand, agree, approve,
ask questions, expect answers (that can be understood).  For those of
you who cannot or don't want to and are satisfied with only what your
doctors tell you...good luck.

Disregarding the fact that 1/2 of all doctors have finished in the
bottom half of their graduating classes, there are really good and
respected doctors who will not readily accept advancement until that
advancement is proven over and over and over.  Many advancements in
prostate cancer treatment, are happening relatively fast.  Do we
discount them because they are new?

After 2 years reading and of receiving <0.1 or "undetectable" test
results, I called Dianon and spoke to the lab manager about
hypersensitive testing and asked why it was thought to be not as good
as the standard test.  His answer was that it was as good, he said he
could repeat the results over and over again with the same accuracy as
the standard test.  Argue with him if you disagree, not me; I heard
what I heard.  I then forced the issue with my doctor and began
hypersensitive PSA testing.

In 2000 I started at 0.04 and from then on until now the 6 month test
results have shown a slow steady increase with only one slight blip
down.  (Some of the tests I had repeated with the same results.
Sounds accurate to me.)  My doctor continues to discount the rise and
has noted that he has had RP patients that have had rising PSA's and
then leveled off (I don't know for how long).  I have also read the
same, so I'm hoping.  However, next April, with my trend, I will no
longer be "undetectable".  I will be somewhere north of 0.1.

Bye the way, for those of you who may reply that I must suffer from
PSA anxiety.  I don't.  Really.  I am not nervous before going for the
blood letting and the poke.  And I don't lose sleep.  But, I do try to
be aware of what is going on with me.

Although the PSA test result is currently thought to be the best
indicator of PCa both pre and post treatment, it is not infallible.
So, with my rising hypersenitive PSA, I have also requested other
blood tests.  My doctor has not recommended any.  But I still got
them.  They are not the topic of this post, and when that information
is more conclusive, I'll share anything of value with this newsgroup
then.

Also, for some of you who may ask, what if the hypersensitive is
accurate enough to predict an early recurrence, what do you do then?
That answer is tougher than believing that the hypersensitive is a
good tool to provide early information.  I don't know...yet, what to
do.  My understanding is that you won't readily get treatment unless
the PSA goes up so fast, in the hypersensitive range, that you are in
the standard range and at 0.2 (the current "magic" number for official
notice) or above by the time an alert doctor agrees to make the
decision to treat you.

However, I do think that you need to get as many facts about your
disease as early as you can.  "Facts" generally mean test results.
Not just PSA.  If they are unremarkable in your opinion, as well as
your doctor's, fine.  If not, YOU have to exercise your right to
pursue the goal of knowledge about yourself and to protect yourself,
and if necessary to get ready to make a treatment decision with a
really good doctor when you know enough.  Wouldn't it be a shame to
miss an earlier chance of effective treatment while your disease more
strongly establishes itself?

Andy

"With positive margins, seminal vesicle involvement, and a very low
PSA
that did increase - why would I want to wait? The technology is
available today that tells me I am not clean of cancer.  If my PSA is
not technically undetectable after the chemo in January I will go to
radiation therapy.  There is still a chance for a cure, and that
chance
is better the sooner I do something about it. I don't believe I'm
"recurrent", I know I the surgery failed to get all the cancer.

Dan, the problem I had w/ your post was that the thread started w/ a
guy worried over a PSA of .04 and you implied to him that he had
recurred and should be getting treatment. You flat out said that the
chemo trial you were in was for failed RPs [not true]; therefore, you
were saying that, since you were in it w/ a PSA of .03, you had a
failed RP. Failed RP or recurrence - call it what you like but there
is no generally accepted medical principle I know of under which you
would be deemed to have had either. The same w/ the initial poster. I
am all for the ultrasensitive test to monitor post-RP patients but the
thresholds for detectability, recurrence, and salvage treatment have
not changed to my knowledge. OTOH, as I stated before, you are at high
risk of recurrence so prophylactic additional treatment for you was
not uncalled for. I don't disagree w/ your decision to proceed based
on that and the minute increase in PSA, but I just don't think it can
be extrapolated that anyone w/ PSA detectable w/ the ultrasensitive
test needs treatment. Are you saying you are going to proceed to RT if
you don't get a PSA below .03? Wow. Are you sure your insurance
carrier will pay for it?

A most important question that arises out of all of this is "in
post-RP patients, what level of PSA, if any, is evidence of PCa as
opposed to benign tissue." Until the ultrasensitive test the lowest
level was <.1 so that was deemed the threshold of detectability, but
now we know PSA can be detected at lower levels. Where is the problem
point? Your doctor may be right that any increase, even below .1, is
evidence of active cancer, and that is not a happy thought for any of
us. But it may well be that some benign tissue left behind can account
for a few hundreths PSA and that the immune system can knock out trace
PCa cells w/o treatment. The question is when do you take action? I am
at .2 and posed it to my doctor as you have here - if it's a question
not of if but when, why wait? Since I have been at .2 for almost a
year now, he thinks I could stay at this level for quite a while w/o
treatment. Of course, if the PCa is metastasizing as we wait, it would
be a horrible mistake.

Bill Denton
RP 2/12/02
Memphis