Regular PSA vs. Ultra-Sensitive

[srtimmons]

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.

[Sephie]

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]

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.

[srtimmons]

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.

[Hawk]

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.

[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

[srtimmons]

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.

[Hawk]

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.

[srtimmons]

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.

[Replicant]

That's a great result!

[Jean222]

Congratulations!

Stay well!


Jean

[johnT]

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

[zumbles123]

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.

[garyfoote]

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.

[Putt]

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.