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Medical Forum / Diseases and Disorders / Prostate Cancer / June 20063 yrs post LRP - PSA up?
After 2.5 yrs of 0.00 ultra sensitive psa results, my 3 yr result came back 0.1 Lab screwed up tho, and ran the standard psa. So this may not be that big a jump. Despite all the posts on this subject over the last 36 months, I can't remember if a 0 reading on the standard psa test comes back as 0.1 or < 0.1 - I am thinking it should have read < 0.1 Either way, a jump from 0.00 to 0.1 in 6 months is pretty big. I had another ultra test taken this morning. LRP 5/21/03 PSA 8.1 Gleason 7 Margins all clean I believe that 0.000 and everything up to 0.099 would be reported as <0.1  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, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum > After 2.5 yrs of 0.00 ultra sensitive psa results, my 3 yr result came > back [quoted text clipped - 12 lines] > Gleason 7 > Margins all clean > ... Despite all the posts on this subject over the last 36 months, I > can't remember if a 0 reading on the standard psa test comes back as 0.1 > or < 0.1 - I am thinking it should have read < 0.1 > ... As I understand it, every PSA test has a certain maximum sensitivity. In other words, there is some PSA level below which the test cannot detect the PSA. A report of "0" is thus misleading. To my knowledge, no test can tell if there is only one molecule of PSA present. How many molecules must be present in the sample to be detectable will vary with the technology used - there are at least two of technologies, maybe more. So your PSA tests could not really have gone from 0 to .1. They must have gone from < something to <= something_else. How the something and something_else are reported depends on the policy of the lab and doctor. It might be that only the terminology used in reporting has changed and that "something" and "something_else" are actually the same in your case. My radiation oncology department reports a minimum as < .2. Their theory is that, for post-radiation patients, .2 is the lowest point at which PSA is meaningful. If you're below that, it doesn't matter how much below. That's a little frustrating for the patient who likes his numbers with lots of decimal places, but I understand their reasoning. In short, if the ".1" really meant "<.1" you may not have actually had any change at all. Alan Well, looks like PCa has likely returned. Repeated psa test came back 0.1 again. -- history on recent tests: previous tests, and I have changed labs on occasion, have always come back <0.04. 6 mths ago, the results came back 0.00 for some reason ( no less than symbol). and then last week results came back 0.1, but they did not run the ultra-sensitive test. so repeated test this week and again 0.1, but I have only had a blackberry email conversation with uro. so still not sure if test was done correctly, and I am pretty sure I am going to run it again this Friday after mtg with uro, but at a different lab. But going forward, assuming return of PCa: Does a rise from 0 to .1 seem like a big jump in 6 mths, after 2.5 years of 0? And what is next? xrt of pelvic area? or watchful waiting until psa shows a continued rise? Thanks all. From: peter*pan@neverland.com (peter*pan) Well, looks like PCa has likely returned. Repeated psa test came back 0.1 again. -- history on recent tests: previous tests, and I have changed labs on occasion, have always come back <0.04. 6 mths ago, the results came back 0.00 for some reason ( no less than symbol). and then last week results came back 0.1, but they did not run the ultra-sensitive test. so repeated test this week and again 0.1, but I have only had a blackberry email conversation with uro. so still not sure if test was done correctly, and I am pretty sure I am going to run it again this Friday after mtg with uro, but at a different lab. But going forward, assuming return of PCa: Does a rise from 0 to .1 seem like a big jump in 6 mths, after 2.5 years of 0? And what is next? xrt of pelvic area? or watchful waiting until psa shows a continued rise? Thanks all. ========> what they did with me when they thought i had a recurrence, was schedule another psa test in 90 days. i ask about another psa test right away and was told by my surgeon that it wouldn't make any difference. i didn't ask him to explain that one. maybe, i should have. anyway, in 90 days you should have your answer. one way or the other. wish i have a better response to offer you. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > Well, looks like PCa has likely returned. > Does a rise from 0 to .1 seem like a big jump in 6 mths, after 2.5 years > of 0? Actually, you really don't know if it's back or what your rise is. You keep going to different labs. You need stability not diversity. At best, or worst, you MAY have had a rise from 0.04 to 0.10, or 6/100ths of a nanogram. If my math is right, that's a rise of 6 billionths of a gram in 2½ years. At that rate, you might be to .75 (that's where I was when I got radiation) by 2010. But, nobody knows. Nobody can even guess. You need to go to one lab that does ultra testing. And get checked every quarter for three quarters. Some have suggested at least every month for three months. THEN you may know what you are dealing with. > And what is next? xrt of pelvic area? or watchful waiting until psa > shows a continued rise? Probably not an x-ray. Maybe radiation. Maybe prostascint scan. 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, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum Sorry Steve - my comment on using multiple labs was not clear. In the 1st 2.5 yrs after lrp, I had 10 psa tests. All came back <0.04, or the odd one 6 mths ago that read 0.00. The reason for lab changes was in the SF Bay Area, labs are like the dot com boom of the 90s - they seem to come and go like weeds! The last 6 psa tests have all come from one lab. Problem is they suddenly dropped the less than, and in at least the one case, and possibly the last (have to see the paperwork), ran the standard test rather than the ultrasensitive. So I may switch labs if I can no longer trust this one to follow instructions, or even possibly report results correctly. > In the 1st 2.5 yrs after lrp, I had 10 psa tests. All came back <0.04, or > the odd one 6 mths ago that read 0.00. The reason for lab changes was in [quoted text clipped - 6 lines] > ultrasensitive. So I may switch labs if I can no longer trust this one to > follow instructions, or even possibly report results correctly. I guess we're lucky here. Room 124 is all I've known for ten years when it comes to blood tests. However, even I had to change when my doctor started doing them in his office. But, you still don't know enough about your actual PSA to take and action (IMHO). If an ultrasenstive test shows you at their lowest possible, 0.04, and a standard test shows you at it's lowest, 0.1, what have you learned. Or, what if your PSA rose 1 hundredth of a nanogram, then the standard would round up to 0.1? All I know is that it is going to take some time for you to find out if you have an actionable PSA rise. > Well, looks like PCa has likely returned. Not yet I think. See below. > Repeated psa test came back 0.1 again. > -- history on recent tests: previous tests, and I have changed labs on [quoted text clipped - 5 lines] > am pretty sure I am going to run it again this Friday after mtg with uro, > but at a different lab. See: http://www.prostate-cancer.org/education/preclin/McDermed_Using_PSA_Intelligentl y2.html for a discussion of test sensitivity. It still isn't perfectly clear to me that the report of ".1" is truly different from the report of "<.04" or "0". The problem is, this latest report is only showing one decimal digit of precision. We don't know whether it was rounded up, rounded down, or whether the technology used isn't able to be more precise at all. In other words, we still don't know if .1 and 0 are really different, or by how much. If the lab had said ".10" then it would be easier to compare to "<.04". But maybe what we really have is a round up of ".05", or worse, maybe we just have a round up of "<.1" to ".1". > But going forward, assuming return of PCa: > [quoted text clipped - 3 lines] > And what is next? xrt of pelvic area? or watchful waiting until psa > shows a continued rise? I'm not a doctor and any advice I give may be worth much less than what you paid for it, but if it were me, I think I'd be inclined to ask for frequent, regular tests and hold off until I saw a completely unambiguous rise. If such an unambiguous rise occurred, then what I would do next would depend on my age and general health. If I were over 80, I'd probably do nothing. If I were under 70, I'd probably want radiation. If I were in between, I'd be inclined towards radiation, but would think harder about it. One more thing I'd try to do is to not bend my whole life around this. Even if you have a recurrence, there is a good chance you can beat it, and if you don't succeed at that, there's a good chance you can live with it. Alan I was reading Alan's post and thinking about questions that I've asked before. Over a year after my surgery...I have had 3 PSA tests which were all reported as 0.0 They use the Beckman-Coulter test, and the doc has worked with Walsh...who, in his book, talks about "PSA Anxiety." I ask about this often...and have learned that some like the 'super-sensitive' tests... and some just say 'undetectable'...which usually means <0.1...which is the same as <.1 I guess...(from what I've learned here and from reading) that 'they' (the docs) don't look at further treatment until the PSA rises to .2 (this is after a RP). This is what I THINK I've learned...I am always open to the educated thoughts that this group provides. Thanks and the very best of health to all, Ron B. Chicago Thanks for the post Alan. I am 51. Tom You seem to be dealing with the same issues that I was a few months ago. You might want to take a look at the thread entitled "salvage radiation after RP" started about 3/17/06 on this newsgroup. No point in repeating the contents of the thread, but IMHO the best advice I got for my situation was I needed 3 consecutive rises using supersensitive tests with the third being >0.1 before seriously considering any salvage therapy. Unfortunately, I met that criteria so I am now in final week of IMRT. Fred 12/ 2003 Radical Prostatectomy at the Cleveland Clinic. Pathology: Gleasons 3+4 = 7, clear surgical margins, but extracapsular extension established. Good recovery from surgery. 3/17/04 PSA 0.003 4/27/04 PSA 0.003 7/22/04 PSA <0.1 (not 3rd generation test) 11/10/04 PSA <0.1 (not 3rd generation test) 5/10/05 PSA <0.1 (not 3rd generation test) 10/19/05 PSA 0.050 2/3/06 PSA 0.082 3/06 PSA 0.110 3-6/06 IMRT I personally know several men who have had salvage radiation after RP and they are doing well. I do hope you have the very same results and then you can finally put the PC behind you. Bev > You seem to be dealing with the same issues that I was a few months > ago. You might want to take a look at the thread entitled "salvage [quoted text clipped - 21 lines] > 3/06 PSA 0.110 > 3-6/06 IMRT Ok, I can't find anything that explains this on the web or in Walsh's book: <0.1 means? (0.99 and less from SteveK) =0.1 means? >0.1 and <0.2 ??? Well 0.1 is not the same as 0.10. If they only use one decimal point, then rounding up or down, it could be anywhere from 0.01 to 0.099 Herb >Ok, I can't find anything that explains this on the web or in Walsh's >book: > ><0.1 means? (0.99 and less from SteveK) >=0.1 means? >0.1 and <0.2 ??? I am actually wondering if 0.1 represents <.15 or even <.19 > Ok, I can't find anything that explains this on the web or in Walsh's > book: > > <0.1 means? (0.99 and less from SteveK) > =0.1 means? >0.1 and <0.2 ??? Actually, it would be 0.099 and less, if I'm right, but if they only report to the first digit, then anything between 0.099 and 0.050 would be 0.1. But, that's assuming that PSA is reported within a mathematical context. 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, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum >Ok, I can't find anything that explains this on the web or in Walsh's >book: > ><0.1 means? (0.99 and less from SteveK) >=0.1 means? >0.1 and <0.2 ??? My lab reports the results of a PSA assay to the nearest 0.1 units. An assay in the range 0.00 to 0.09 is reported as <0.1. An assay b between 0.10 and 0.14 is reported as 0.1. An assay between 0.15 and 0.24 is reported as 0.2 . Received some clarity on my psa today: 10/19/05 - 0.00 - ultra 4/24/06 - 0.1 - standard 5/26/06 - 0.1 - standard 6/2/06 - 0.05 - ultra (new lab) Last test was at a different lab, as previous lab suddenly forgot how to follow instructions and run ultra-sensitive rather than standard psa test. 10/19/05 test also came back 0.00, rather than <0.04 as it always had before. Not sure what they are smoking over there... So psa of 0.05 is much better than .1, but Uro is still concerned it represents a change. Will retest in a month. Uro also wants me to keep appt with Rad Oncologist. What do you all think of the psa, and going forward with at least meeting with the RadOnc? Thanks! Tom *********** LRP 5/21/03 -- age: 48 PSA 8.1 Gleason 7 Margins all clean PSA thru 2005 undetectable PSA 6/2/06: 0.05 Tom, My first psa post-op was 0.2. Not what you would hope for. I went into panic mode and set up an appointment with a rad oncologist my uro recommended and had a second test at a different lab. The second test came back <0.1. I still kept the appointment with the oncologist and found it worth the time, at least from an educational stand point. The oncologist turned out to be plain spoken and informative. Fortunately, 5 1/2 years and counting, I haven't had to worry about it again. I would suggest that you not panic until more is known, though I clearly couldn't follow my own advice. Good luck, Robbie > Received some clarity on my psa today: > 10/19/05 - 0.00 - ultra [quoted text clipped - 26 lines] > PSA thru 2005 undetectable > PSA 6/2/06: 0.05 > So psa of 0.05 is much better than .1, but Uro is still concerned it > represents a change. Will retest in a month. [quoted text clipped - 3 lines] > What do you all think of the psa, and going forward with at least meeting > with the RadOnc? I think your uro is a pessimist. A 0.05 is a very, very good PSA. 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, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum < A 0.05 is a very, very good PSA.> It does represent a change, however, from 2.5 years of no psa. I understand that can be attributed to: 1) benign prostrate tissue left behind, that finally recovered sufficiently from surgery to register 2) #1 that has become PCa 3) PCa that escaped or was left behind Are #1 & #2 actually based on fact or fiction? Or no one is sure? > < A 0.05 is a very, very good PSA.> > It does represent a change, however, from 2.5 years of no psa. I [quoted text clipped - 4 lines] > 3) PCa that escaped or was left behind > Are #1 & #2 actually based on fact or fiction? Or no one is sure? #1, benign prostatic tissue left behind that continues to slowly grow is a demonstrated possibility, see the abstract below. The rate of PSA increase from here on out should differentiate between the benign and cancerous tissue possibilities. Continued use of the ultrasensitive test (use the same lab) will provide an earlier answer to this question...ron Urology 2003 Feb;61(2):380-5 Biochemical recurrence without PSA progression characterizes a subset of patients after radical prostatectomy. Prostate-specific antigen. Shinghal R, Yemoto C, McNeal JE, Brooks JD Department of Urology, Stanford University Medical Center, Stanford, California 94305-5118, USA. OBJECTIVES: To characterize a subset of patients with biochemical recurrence after radical prostatectomy but with little, if any, subsequent rise in serum prostate-specific antigen (PSA) and no clinical progression during long-term follow-up. METHODS: Of a series of 600 patients, 158 with biochemical recurrence after radical prostatectomy were examined. We identified a subset with measurable serum PSA levels during long-term follow-up, but with very low PSA velocity and no clinical recurrence. Serum PSA was measured with the ultrasensitive TOSOH assay with a PSA recurrence defined as a serum PSA of 0.07 ng/mL or greater. RESULTS: We identified 14 patients (8.8% of biochemical recurrences) with a detectable serum PSA level after radical prostatectomy yet without clinical or PSA progression at a mean follow-up after radical prostatectomy of 10.3 years. The mean time to PSA recurrence was 5.8 years, and the mean PSA velocity after recurrence was 0.028 ng/mL/yr. No clinical or pathologic features were found that could be used to identify this subset of patients. CONCLUSIONS: A subset of patients with biochemical recurrence after radical prostatectomy will not exhibit a progressive rise in serum PSA or clinical progression at 10 years follow-up. This suggests that serum PSA kinetics should be observed after biochemical recurrence before adjuvant hormonal therapy or radiotherapy. Thanks to those of you who followed this thread with some thoughts and advice. Today I met with my GP, in whose offices the lab that seemed to have run the wrong test rents space. We spoke with the head of the lab and she insisted that they ran the ultra-sensitive tests, and stated that about 6 months ago they stopped designating on the lab results which test was run. I also checked with insurance, and the tests were billed as the more expensive ultra-s test. Does that seem odd to you all? Also, that would mean the following on my last 4 psa tests: Received some clarity on my psa today: 10/19/05 - 0.00 - ultra (lab A) 4/24/06 - 0.1 - ultra ? (lab A) 5/26/06 - 0.1 - ultra ? (lab A) 6/2/06 - 0.05 - ultra (lab B) What do you make of these results? Thanks, Tom Yes it seems odd. It seems like the 2nd and 3rd test were standard and should have been reported <0.1. Did your GP show you the lab report? I started having my GP write the script for my lab tests since my uro dropped out of my health plan. He missed the "<" on the lab report. Fortunately, I was there when he told me. Robbie > Thanks to those of you who followed this thread with some thoughts and > advice. [quoted text clipped - 18 lines] > > Thanks, Tom Finally got the lab confusion cleared up - they were reporting #s incorrectly (rounding) but running ultra-sens test. 10/19/05 - 0.00 - (Hunter) 04/24/06 - 0.10 - (Hunter) 05/26/06 - 0.10 - (Hunter) 06/02/06 - 0.05 - (Quest) 06/09/06 - 0.06 - (Hunter) Also, met with rad-onc yesterday. If #s turn up again and bump over .10, we'll go with IMRT. Tom ********** LRP 5/21/03 (age 48) PSA 8.1 Gleason 7 (3+4) Margins all clean 1 nerve spared PSA thru 2005 undetectable > ... > Also, met with rad-onc yesterday. If #s turn up again and bump over .10, > we'll go with IMRT. > > Tom > ... Best of luck Tom. Let us know how things turn out. Alan > Finally got the lab confusion cleared up - they were reporting #s > incorrectly (rounding) but running ultra-sens test. [quoted text clipped - 4 lines] > 06/02/06 - 0.05 - (Quest) > 06/09/06 - 0.06 - (Hunter) The last four values look to me like random variation of a constant quantity. In other words, the true value is about .0775 and the variation in testing is about 0.025. They may claim their tests are more accurate than that, but given the numbers, I would be suspicious of any such claims, although the variation could also be because of things happening in your body. The measurements were all taken very close in time, so they represent the current value, and won't tell you much about what is going to happen in the future. The important point is that apparently, to within the accuracy of this test, the value is not zero. That might mean there is some prostate tissue, perhaps cancer, somewhere in your body which is still producing PSA. If it never starts rising in a consistent manner, you need not worry about it. I believe some others treated by RP in this group have had such an experience. If it does start going up, IMRT would seem advisable. Good luck! > Also, met with rad-onc yesterday. If #s turn up again and bump over .10, > we'll go with IMRT. [quoted text clipped - 9 lines] > 1 nerve spared > PSA thru 2005 undetectable > The important point is that apparently, to within the accuracy of this > test, the value is not zero. That might mean there is some prostate > tissue, perhaps cancer, somewhere in your body According to Walsh (or maybe it was Scardino) some men have a patch of normal, harmless, but PSA-producing cells around their kidneys. This article is also rather interesting: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=138688 Finally, there will often be some non-cancerous prostate cells left at the site of the RRP. So a low PSA reading that does not really change over time is probably nothing at all to worry about. Remember - PSA is not a disease in itself and does not need to be cured, it is simply an indicator that requires interpretation in context. SignaturePeter Headland Fascinating link. They referred only to the female breast tissue and milk ducts yet men are at risk for breast cancer, too. That leaves me to contemplate the difference between the male breast and the female breast. Hmmm. Bev > > The important point is that apparently, to within the accuracy of this > > test, the value is not zero. That might mean there is some prostate [quoted text clipped - 11 lines] > cured, it is simply an indicator that requires interpretation in > context. I think Leonard's right on target and his comments are consistent with the advice I received from the various experts when I was faced the same issues a few months ago. At the PSA levels you report, I would need to see consecutive rises in PSA over several months before I would seriously consider IMRT. Fred Looks like normal variability to me. Lab-to-lab results can differ. I had two blood draws at the same time. Sent them to two labs. One was PSA 6, the other was PSA 9. (both cancer and prostate infection in progress) I've seen that kind of variation between these two labs previously, and the American Cancer Society's "Copmplete Guide ..." book mentions lab-to-lab variability and time-to-time variability. > Thanks to those of you who followed this thread with some thoughts and > advice. [quoted text clipped - 18 lines] > > Thanks, Tom
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