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Medical Forum / Diseases and Disorders / Prostate Cancer / July 2009PSA after 9 years and 9 months
My 10 year less 3 months....PSA 7/15/09 @ Stanford Hospital Component Results: Post - therapy PSA Value 0.05 (H) Range <0.02 ng/mL Dr. Brooks comments: John, This is fine- like to see it <0.1 I am not sure how I interpret this. Wanting to see it <0.1 and what came up. Any comments or clarification would help me understand as to what this all means. Always something...... john > My 10 year less 3 months....PSA > 7/15/09 @ Stanford Hospital [quoted text clipped - 14 lines] > Always something...... > john I'm not sure what the two different numbers above mean. Does "Post - therapy PSA Value 0.05" mean that's the number you had immediately after surgery and <0.02 is the number you've got now? Or is 0.05 the number you've got now and "<0.02" describing the sensitivity of the test? In either case, it looks to me like you're still in good shape. 0.05 and 0.02 are both less than .1. The doc was just commenting on the fact that your PSA is still down in the cellar where you want it to be. Looks like you're good to go for another 10 years. Alan Hi Alan, I see that the Lab report says, Component results are 0.05 and that must be the test I just had. the range is <0.02 I wish it were more clear for me. This test always raises my feathers...... Thanks for your input. john >> My 10 year less 3 months....PSA >> 7/15/09 @ Stanford Hospital [quoted text clipped - 31 lines] > > Alan : My 10 year less 3 months....PSA : 7/15/09 @ Stanford Hospital [quoted text clipped - 12 lines] : Any comments or clarification would help me understand as to what this all : means. My first impression is that he misspoke. If your lab uses an assay that records to 0.02, then the best you could hope for is a result of <0.02. Maybe he meant to say "<0.01" and didn't understand the assay's lowest result. Maybe he wasn't thinking about the number at all and was trying to impart his desire that you and he would rather see a "<" (less than symbol). The good news is that it has been my experience (about 7 years of it) that PSA ebbs and flows under the 0.10 range and seems to mean nothing until it rises above that mark. However, in a pure world, one would like to see a value less than what any particular assay can register. I am sure you're probably thinking, "I was 49 when this started 10 years ago with a Gleason 8 and my luck has finally run out." If so, I think your thinking is premature and it confounds me why doctors would use any assay other than the standard in cases like yours.  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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA undetectable since; last checked on 06/04/09 Illegitimati non carborundum Hi Steve, My Gleason was actually 7 prior to RP and with lab work done after surgery Gleason came back 6. (pretty sure-remember looking at lab and surgery records that were given to me) Anyway, thanks for the input.....I guess this anticipation never leaves a prostate cancer survivor. Wish they had a drug to relieve the anticipation. John > : My 10 year less 3 months....PSA > : 7/15/09 @ Stanford Hospital [quoted text clipped - 32 lines] > thinking is premature and it confounds me why doctors would use any assay > other than the standard in cases like yours. On Jul 22, 5:45 am, "Steve Kramer" <skra...@cinci.rr.com> wrote...snip... > it confounds me why doctors would use any assay > other than the standard in cases like yours. Steve...As has been discussed here before, there are numerous studies showing that ultrasensitive PSA tests are reliable and accurate, especially with regards to trends, when performed in controlled laboratories. There are also numerous studies that show that the ultrasensitive test provides (ballpark) 3-12 month advanced notice of biochemical recurrence as compared to the standard test. A number of doctors including Dr. Strum recommend the ultrasensitive test for their post-treatment (surgery and hormonal treatment) patients. If you have recurred, you will learn of it sooner (ultrasensitive test) or later (standard test). Given this, I see advantage to "sooner". It gives you more time to recover from the initial disappointment, do some research and make some critical decisions...ron On Jul 22, 5:45 am, "Steve Kramer" <skra...@cinci.rr.com> wrote...snip... > it confounds me why doctors would use any assay > other than the standard in cases like yours. Steve...As has been discussed here before, there are numerous studies showing that ultrasensitive PSA tests are reliable and accurate, especially with regards to trends, when performed in controlled laboratories. There are also numerous studies that show that the ultrasensitive test provides (ballpark) 3-12 month advanced notice of biochemical recurrence as compared to the standard test. A number of doctors including Dr. Strum recommend the ultrasensitive test for their post-treatment (surgery and hormonal treatment) patients. If you have recurred, you will learn of it sooner (ultrasensitive test) or later (standard test). Given this, I see advantage to "sooner". It gives you more time to recover from the initial disappointment, do some research and make some critical decisions...ron ==> I do not refute that these studies and theories have occurred and results were just as you said. But, I have not heard about any doctors who make a move at those levels. Which leaves the patient with the theoretical time only for more research. Conversely, we have John concerned for three months as to whether he's going to be a 0.08 in October or back below the thermal layer. Now, if John's doctor is one who will act if it hits 0.08, then I understand causing John's anxiety. But, it has been my experience, at least through this (admittedly anecdotal) NG, that harm has been caused and no doctor does anything below 0.10, some below 0.2, and others as high as 2.0. But then I don't have total recall. I would love to hear from those whose doctors have selected a milestone below 0.10. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA undetectable since; last checked on 06/04/09 Illegitimati non carborundum > On Jul 22, 5:45 am, "Steve Kramer" <skra...@cinci.rr.com> > wrote...snip... [quoted text clipped - 44 lines] > PSA undetectable since; last checked on 06/04/09 > Illegitimati non carborundum Steve...Just to be clear, I'm not advocating acting at ultrasensitive levels, but rather to use the additional time to one's advantage. As I said up above, if you've recurred, then sooner or later you will find out. Sooner or later you will be thrown for a loop. Sooner or later you will be anxious about that next PSA measurement. In addition to the additional time the ultrasensitive test provides to emotionally recover, plan and prepare; it also allows you to collect more data and hence make a better estimate of your doubling time. Just to make the point, suppose you've decided to be treated for recurrence if and when your PSA reaches 0.20 ng/ml (a commonly used break-point) and you are using the standard test. Your PSA has been undetectable, the most recent test has come back at 0.18 ng/ml. What is your doubling time? If you want to be treated at the lowest PSA that is >0.20 then you don't have much time or information. Had you been using the ultrasensitive test (<0.01 ng/ml), you might have had readings at 0.04, 0.08, 0.16. Time to think, plan and have a reasonable estimate of your doubling time (and hence an estimate of the aggresiveness of your disease)...ron ..ron Steve...Just to be clear, I'm not advocating acting at ultrasensitive levels, but rather to use the additional time to one's advantage. As I said up above, if you've recurred, then sooner or later you will find out. Sooner or later you will be thrown for a loop. Sooner or later you will be anxious about that next PSA measurement. In addition to the additional time the ultrasensitive test provides to emotionally recover, plan and prepare; it also allows you to collect more data and hence make a better estimate of your doubling time. Just to make the point, suppose you've decided to be treated for recurrence if and when your PSA reaches 0.20 ng/ml (a commonly used break-point) and you are using the standard test. Your PSA has been undetectable, the most recent test has come back at 0.18 ng/ml. What is your doubling time? If you want to be treated at the lowest PSA that is >0.20 then you don't have much time or information. Had you been using the ultrasensitive test (<0.01 ng/ml), you might have had readings at 0.04, 0.08, 0.16. Time to think, plan and have a reasonable estimate of your doubling time (and hence an estimate of the aggresiveness of your disease)...ron ..ron ==> I cannot debate such logic. I guess I will have to detract the comment that I am confounded by doctors who test at those levels. That said, I personally would rather have the aprehension at the same time that I can act on it. I won't need six months to ramp up on research and I disdain waiting around to solve a problem. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA undetectable since; last checked on 06/04/09 Illegitimati non carborundum > Steve...Just to be clear, I'm not advocating acting at ultrasensitive > levels, but rather to use the additional time to one's advantage. As [quoted text clipped - 34 lines] > PSA undetectable since; last checked on 06/04/09 > Illegitimati non carborundum I tend to believe the <.1 works quite well to avoid the unnecessary anxiety. My brother was Gleason 8 , PSA 6.3 with open surgery and followup radiation. He lasted 7 1/2 years believing he was cured so now anxiety. When it recurred it was 1.3 and doubled every 3 months. It took him a year of research with Strum and all the others and many scans and test until his PSA reached 16 before he opted for triple blockage. His psa went down vary fast to .02 and has remained there dor a year. He is now going to single blockage and monitoring. Ron S. On Jul 23, 6:26 am, "Steve Kramer" <skra...@cinci.rr.com> wrote: > "ron" <oit...@yahoo.com> wrote in message now anxiety. When it recurred it was 1.3 and doubled every 3 months. It took him a year of research with Strum and all the others and many scans and test until his PSA reached 16 before he opted for triple blockage. His psa went down vary fast to .02 and has remained there dor a year. He is now going to single blockage and monitoring. ==> It would not take me a year. I guess if one knew nothing of what might be next, then knowing at 0.08 could be a benefit. I'm thinking that if mine goes over 0.10 (when mine goes over 0.10), I'll be able to brush up on tactics within weeks. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA undetectable since; last checked on 06/04/09 Illegitimati non carborundum > On Jul 23, 6:26 am, "Steve Kramer" <skra...@cinci.rr.com> wrote: > [quoted text clipped - 23 lines] > PSA undetectable since; last checked on 06/04/09 > Illegitimati non carborundum One must consider the fact that he already had 36 treatments of radiation as a precaution. Whether it helped or not no one really knows. However, because he broke his back and had all the hardware in place and after intense therapy, he wasn't about to jeopardize that with any more radiation. The only suspicious spot he had was L12 I believe. He will be having more scans in the near future to see if anything shows up. The point I was attempting to make (anecdotal and all) , was it didn't seem to make much difference when he started triple blockage as it brought down the PSA immediately and it has remained there for a year. Ron S My guy says, in speaking to me, that what you want is <0.1; which is undetectible. He does not put much stock in ultra sensitive tests and has found that most readings are on a rollercoaster and all that does is to serve as an anxity builder among patients. Anyway, your results are excellent. Keep up the good work. GD > : My 10 year less 3 months....PSA > : 7/15/09 @ Stanford Hospital [quoted text clipped - 32 lines] > thinking is premature and it confounds me why doctors would use any assay > other than the standard in cases like yours. It says that your result is right where he wants it to be. You are less than 0.1 and that is what he likes. You like it as well. I interpret this as the best possible response to treatment. > My 10 year less 3 months....PSA > 7/15/09 @ Stanford Hospital > Component Results: > Post - therapy PSA Value 0.05 (H) Range <0.02 ng/mL > Dr. Brooks comments: > John, [quoted text clipped - 8 lines] > Always something...... > john I see your point. If I were say helping a young baseball enthusiast out and he kept dropping the ball in a play I would say, "I would like to see you catch a few more" I guess I interpret "like to see" as something that I have not achieved...... that is my confusion-interpretation of wording. I may have to consult a semantics pro. john > It says that your result is right where he wants it to be. You are > less than 0.1 and that is what he likes. You like it as well. I [quoted text clipped - 19 lines] >> Always something...... >> john > My 10 year less 3 months....PSA > 7/15/09 @ Stanford Hospital [quoted text clipped - 14 lines] > Always something...... > john Hi John...I think this means that your PSA was detectable at 0.05 ng/ ml and that this value is high (H) given that the expected post- surgery range for this lab is less than 0.02 ng/ml (<0.02). Dr. Brooks' comment indicates that as long as your PSA is less than 0.1 ng/ ml (<0.1), he's not concerned. Did you use this same lab for your last PSA test? If so was the value from your last test different from 0.05 ng/ml? In any case, you might want to contact Dr. Brooks and ask him your question directly. You've paid for a service; if you have questions they should be answered as part of this service. Dr. Brooks is top-notch, I suspect he also wants his patients to be completely satisfied with any service he provides...Best wishes and good health, ron > > My 10 year less 3 months....PSA > > 7/15/09 @ Stanford Hospital [quoted text clipped - 27 lines] > satisfied with any service he provides...Best wishes and good health, > ron It seems to me that Steve and ron are tlaking at cross purposes. Apparently, Dr. Brooks feels that variations below 0.1 ng/ml are meaningless. In particular, that would mean that he doesn't believe that this is necessarily the beginning of a trend. On the other hand, ron points out that if you believe that these ultrasensitive variations are significant, and can be helpful in establishing the doubling time early, you can use that time to prepare. If John agrees with ron, I think he should probably find another doctor to advise him. Otherwise, my feeling is that John should ask Dr. Brooks just why he is not specially concerned, and upon getting a satisfactory answer, try to forget about the matter for the present.. Also, I am very happy that my urologist doesn't use ultrasensitive tests. If my PSA starts rising, I won't know about it until it exceeds 0.1, and I suspect that even if that happens I won't begin HT until there is strong evidence of clincial progression. The evidence that early use of HT in a case like mine will extend longevity is not clear, and I don't want to suffer side effects from HT if I can avoid them. I am now 76, and whether my cancer recurs or not, I may luck out and avoid the effects of prostate cancer, dying of something else first. Good luck John. Keep your spirits up. |
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