Regular PSA vs. Ultra-Sensitive

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

Part of this choice is medical but part is also philosophical.

For starters I have strong reason to believe that most one decimal tests round up so the moment you hit .05 it will indicate .1 This means there is no difference of when you would be alerted at the first real evidence of "detectable recurrence". I am now glad I had relative peace for 4 years when my PSA was likely going .02 - .03 - .04 and I was reading <.1.
I lost NOTHING and gained some peace of mind.

The next point is few men would opt for salvage radiation at .05 or .06 since there is a small chance of remaining prostate tissue causing a small steady reading up to the .10 range.

So as JohnT stated, a sensitive (2 decimal) test is not useful pre-surgery. It is also not medically useful pre- getting your first .1 reading because no treatment options would be initiated in this range. Once I got a .1 reading (which is really greater than .04), switching to the 2 decimal test helped me decide when to initiate salvage radiation well within the recommended guidelines for best outcome. When I got my first .1 test the 2 decimal test revealed my PSA was really .06. This allowed me to have two consultations and pull the trigger on salvage radiation after I was sure I was above .11

The 2 decimal test also now matches my philosophical need to precisely track the impact of that salvage radiation on my cancer. I am still not sure it would alter the timing of any future treatment however.

In my opinion there are SOME medical and a lot of philosophical reasons involved in the choice between the two tests.
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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

Sephie · Regular Joined: 24 Apr 2008 Posts: 31

due to our recent experience with my husband's PSA after surgery in March 2008. His urologist and "regular" MD only report PSA to 1 decimal place. For 17 months after surgery, husband's PSA was reported to us as 0.0. In August of this year, it came back at 0.1; another test 30 days later came in at 0.3. At the urologist's suggestion, we spoke with a radiation oncologist. All pre-RT tests have been done with a follow-up CT scan of his chest scheduled this week because the bone scan showed one "hot spot" in the collarbone. The third - and final - PSA test was taken last Friday. Keep in mind that we were ready to pull the trigger on RT after this week's CT scan. On Saturday, the urologist called to say that hubbie's PSA has come back as undetectable - less than 0.1!

I tell this story only to demonstrate that if we had been using an ultra-sensitive PSA assay, there's a chance we would have begun salvage radiation sooner when it might not have been necessary. I think you have to weigh the pros and cons of what an ultrasensitive test might be telling you and understand the risks that could be inherent in taking action too quickly. Of course, it's a double-edged sword because the sooner you begin salvage radiation, the better the outcome.

Both our radiation oncologist and urologist feel that the ultrasensitive test doesn't have a diagnostic value (at least to them). Even in my husband's case, with one of his PSA readings being 0.3, they both felt the PSA was still very low and were not convinced that we were seeing a recurrence. As it turns out, at least for now, we are not.

Another PSA will be done in early December. We are both fully aware that we're not out of the woods yet but are certainly grateful for the good news.

I hope this helps someone on this forum.

Have a great day!

Putt · Regular Joined: 04 Aug 2009 Posts: 27 Location: Kansas

PSA is not the only factor to consider when making the decision whether to have salvage radiation or not. Important factors include your pathological staging and final Gleason score.

I was Dx'd with advanced PC, that had escaped the capsule and spread into the seminal vesicles. As a result, I hit the beast with every thing available. ADT, RRP, and RT, then started monitoring with the ultra test. I realized that I had cancer, and I still have it somewhere in my body. The ultra lets me know if and when it is coming out of remission and at some point in time, of my chosing, I will start treatment again. I just as soon not be suddenly surprised that it has approached that trigger point.

If I had started this journey with lower numbers, then I would probably look at it differently, but I have to work with what I have been blessed with. Its been 5 years so far and I'm still here looking forward to the next 5. Good luck to all.........
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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. Will start ADT3 after PSA reaches 1.2.

Joe Hutt · Posted: Wed Nov 04, 2009 1:12 am Post subject: Getting a clear reading

Good topic, I think that if you are going to have the ultra-sensitive PSA test (3 decimal places) one needs to know what time gap is required between tests to enable to get a clear reading?? especially if you are trying to get any medication settle to the smallest dose required.I have the test done every two months, believing that gives a clear indication of how much prostasol I should take. The most important result is consistency, if it is, say 0.01 and it stays there +or- I dont know 0.05 that would keep me happy.
What do you think out there.
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