Regular PSA vs. Ultra-Sensitive

srtimmons · Posted: Wed Aug 19, 2009 4:41 pm Post subject: Regular PSA vs. Ultra-Sensitive

I 'd like to start a discussion about the pros and cons of the regular PSA test (1-2 decimal places) versus the ultra-sensitive PSA test (3 decimal places).

My surgeon prescribes to the ultra-sensitive test and looks for anything below .003 as good. I know in the regular PSA, they look at .1 as being the threshhold. I'll find out on Sept. 1 my next appointment and first post-RP PSA.

I also read Walsh's book and noted he is not a fan of the ultra-sensitive.

What do readers here have to say about each of these?

I'll start:

Ultra-sensitive pro: measures more minute changes, so additional treatment can be started sooner, if needed. Con: minute fluctuations may cause needless anxieties.
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative.
Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

PSA .006 September 2009
PSA .005 November 2009
PSA .005 February 2010

Sephie · Experienced user Joined: 24 Apr 2008 Posts: 50

I just saw your post. My husband and I were just discussing switching to an ultra-sensitive PSA. Husband's surgery was March 2008 and his PSA results have been 0.0 since then. In August, his PSA reading was 0.1. Doctor wants to retest in 1 month (rather than 3 months). Doctor is not concerned but, obviously, we're going to keep a very close watch. Husband spoke with the doctor about using an ultrasensitive test going forward to monitor changes. Doctor said his experience is that they really don't tell "us" anything. The minute changes that this test reveals, in his opinion, has no valid diagnostic value and often causes undue anxiety. Deciding on adjuvant therapy (e.g., radiation) based on the minute fluctuations in an ultrasensitive test is not advisable - in our doctor's opinion.

Husband also discussed ProctaScint to determine if there is a local recurrence. Again, the doctor said he has used it but very infrequently as there are still high percentages of false positive and false negative results.

Hawk · Senior User Joined: 22 Nov 2006 Posts: 425

I thought switching from a one decimal test to a two decimal test was useful since I was dealing at the very low end of PSA (.06-.15 range) All of this was showing .1 on the one decimal test. On this two decimal test most centers of excellence consider anything below .05 as test "noise" and not even necessarily a real PSA reading. It is hard to see a value in a 3 decimal test.

On another forum, there is an interesting/revealing account of a guy that had a daily PSA test for a long period of time.

I would like to have a female take a 2 or 3 decimal PSA test. I am willing to bet they would get some reading.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

srtimmons · Posted: Fri Sep 04, 2009 3:49 pm Post subject: Dr. appointment

Had my 6-week post surgery appointment yesterday. My doctor, Dr. Slawin of Houston, uses the ultra-sensitive PSA test.

He looks for anything under 0.03 as good whereas the other threshhold in use today by Waslh, et al is 0.1. I asked him about the controversy and he has done significant research about PSA testing and feels the ultra-sensitive test gives a better chance to detect PCa recurrence sooner and then to treat it effective with salvage methods.

As a layperson, beats me as to which is best. I just happen to be in the ultra-sensitve camps right now. Intuitively, since PSA should be 0.0 with no prostate cells, any level of PSA, if accurate, would mean cells are still out there making PSA and should be dealt with.

I will know my test result by Tuesday.
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative.
Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

PSA .006 September 2009
PSA .005 November 2009
PSA .005 February 2010

Hawk · Senior User Joined: 22 Nov 2006 Posts: 425

In your first post you classified a 2 decimal test as regular (0.03) and suggest a 3 decimal test is sensitive. I never heard of a 3 decimal PSA test.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

srtimmons

Yep, I was wrong. It is not 3 decimal places. Dr. told me yesterday he looks for PSa of <0.03 ng/ml as good. Anything higher as suspect.

Hoping I'm less than that when I hear.

GL
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative.
Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

PSA .006 September 2009
PSA .005 November 2009
PSA .005 February 2010

srtimmons · Posted: Tue Sep 08, 2009 6:23 pm Post subject: Got my answer

My first post-RRP PSA came in today at 0.006. A good starting point. Another PSA test in 3 mos.

Good luck to everyone esle.
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative.
Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

PSA .006 September 2009
PSA .005 November 2009
PSA .005 February 2010

Hawk · Senior User Joined: 22 Nov 2006 Posts: 425

Congratulations!!!

Is that .003 or .03 ??? I have not heard of a 3 digit test.

In any case it is a number to cheer about.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

srtimmons · Posted: Tue Sep 08, 2009 9:59 pm Post subject: ultra-sensitive

I had been confused about it, too.

Buy my PSA on today's lab report is now 0.006 NG/ML, so the ultra-sensitive does go to 3 decimal points. So it suggests very few prostate (regular or cancerous) cells were left. The lab reports shows 0.1 as the "reference range" with me comfortably below it at this point.

But like everyone else, I have to monitor it every few months. With PCa you just never can rest easy.
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative.
Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

PSA .006 September 2009
PSA .005 November 2009
PSA .005 February 2010

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

That's a great result!
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 262

Congratulations!

Stay well!

Jean

johnT · Senior User Joined: 27 Apr 2009 Posts: 235

The ultra sensitive PSA is only useful after surgery in order to determine a reoccurrance. It can pick up a rising psa trend far faster than a normal psa enabling one to start a salvage procedure sooner,
Another use is to designate a nadir when using HT. Those achieving a nadir less than .05 while on HT have a much better progonosis.
For regular use an ulta sensitive does not add any more information.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

zumbles123 · Regular Joined: 24 Jul 2009 Posts: 15 Location: Powell

My husband just got his post RP PSA: less than 0.08. He had been taking Propecia for years, and no one was sure if this should be doubled. So, I posed this question to the esteemed Dr Strum on p2p.org. Dr Strum indicated that this value should be doubled. However, he doesn't believe you get a true value unless you use ultrasensitive testing ie: what does "less than "0.08 mean numerically, and how can you double something indefinite. Also, he mentioned he did not consider 0.08 undetectible and that values greater than 0.01 increased the probability of biochemical reoccurance. You can view his response to me on p2p.org; my name is Claire. He talks about regular vs sensitive testing and cites studies regarding this. He advocates use of ultrasensitive tests.
_________________
claire1

garyfoote · Posted: Wed Sep 09, 2009 4:42 pm Post subject: 2 decimal place PSA

Since my surgery in April 2008 my PSA has slowly risen to the point where I was told I had to have followup salvage radiation at 0.06. The day of the 'dyu run' before starting actual Rads I insisted on another test and lo and behold it had dropped to 0.04. Since then it has risen once more to 0.07 but I am confident that I have reached my natural 'float' level where I will rise and fall within a specific range due to the release of PSAs from many other glands that produce the antigens.

I agree that a 3 decimal point test is unnecessary. Too much stress over miniscule changes.
_________________
Gary

Initial PSA 24.8. Jan 08
Second PSA 18.8. Feb 08
Biopsy Mar 08. 12 cores. 7 positive.
Gleason 8 [4+4]
Radical Retropubic Prostatectomy 04/29/08
Diagnosed mucinous adenocarcinoma
Positive margin shows in slides
PSA 0.0 8 weeks after surgery
Bilateral Inguinal Hernia Repairs 7/10/08
PSA 0.02 October 2008
PSA 0.04 December 2008
PSA 0.06 March 2009
PSA 0.04 April 2009
PSA 0.07 July 2009
PSA 0.15 October 2009
PSA 0.17 January 2010

Putt · Regular Joined: 04 Aug 2009 Posts: 36 Location: Kansas

Some doctors claim that the Ultra test causes unecessary mental anguish and refuse to allow the test. Possible? Yes possibly. But I think that most men would prefer to know where they stand with their treatments.

You will note on my signature line that I have been there and done that. From day one, especially after reading Dr. S. Strum's book, "A Primer on Prostate Cancer", I have always insisted on the ultra test. Reasons being?

First of all I have Prostate Cancer. After all of the treatments, I still have PC. I will continue to have PC, and hope when its time, I go because of something else instead of PC. My PC is in remission. How do you know when it is starting to rear its ugly head again? You use the only tool that is available that monitors the beast much earlier than the regular test.

For example, over the past several years, if I had only the regular test, my PSA would have indicated <0.1. When the undetectable standard is usually recognized at 0.05, how would I have known if it was undetectable? My ADT holiday was based on my level being UDT for a period of at least 12 months and a testosterone level less than 30. Because of the ultra test, I have been able to enjoy over 2 years without Lupron.

Now because of the ultra, I have noticed that the level has slowly started to rise (as expected) and I am preparing to do battle again in the not too distant future. Since I am aware that I have cancer, I am not going ballistic because of a small increase. There are too many other things in this world to worry about.

Many might disagree with me, but I'm not going to do battle over it. Its my life. I just thought I'd share my reasoning.
_________________
PSA at Dx 105 at age 68, 4/04. ADT, RRP, 5/04. Gleason 4+5=9, Staged pT3c N0 MX, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09. Will start ADT3 after PSA reaches 1.2.

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