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Thread: 5 weeks post prostatectomy psa

  1. #1
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    5 weeks post prostatectomy psa

    Hi

    The Quest report says PSA, TOTAL <0.1 using the Siemens chemiluminescent method

    Question 1. Does this mean: less than 0.1?

    Question 2. Is this undectable?

    Thank you

  2. #2
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    Hi fallonboy - YES, that is EXACTLY what it means! The test was done with a STANDARD assay material, which has a reliability threshold of 0.1 ng/ml. The long established clinical definition of "undetectable" PSA is LESS THAN 0.1 ng/ml (reads <0.1 ng/ml). As long as it REMAINS there, you are considered to be Prostate Cancer (PCa) FREE. That is the purpose of regular post-treatment PSA monitoring which is, hopefully, to confirm the continuing stabilization of the "undetectable" status of the patient's PSA.

    The presence of the "less than" icon (<) PRECEDING the numerical number, ALWAYS indicates that the number immediately following is the tests recognized level of reliability. Any reading found below that figure, IF ANY, is therefore UNRELIABLE and thus is reported only as below the recognized threshold of reliability.

    There are now Hyper- and/or Ultra-sensitive assays now available, which TECHNICALLY have the ability to produce "reliable" results down to 100th or 1000th of a nanogram (ng) per millilitre (ml) of blood. This MAY have pragmatic value in application to specific individual cases of particularly high risk and/or ADVANCED PCa, but has little or no practical clinical value in the ROUTINE monitoring of low and/or moderate risk patients, post-surgery. Their use in ROUTINE monitoring often causes excessive UNWARRANTED and UNNECESSARY, stress on patients. This is because such sensitive findings are subject to an excess of non-biological laboratory variations, such as "background noise", subtle assay batch variations, and equipment/calibration procedures, which are not likely to affect the STANDARD assay. IF the PSA stabilizes, and remains so, at a level below 0.1 ng/ml, IT SIMPLY DOESN"T MATTER what readings are below that level.

    Following my signature, is an article from Johns Hopkins Medical Center that addresses this subject. Just because something CAN be done, does NOT necessarily mean that it SHOULD be done! I hope this helps. - John@newPCa.org (aka) az4peaks

    A Publication of the James Buchanan Brady

    PROSTATE CANCER UPDATE
    Urological Institute Johns Hopkins Medical Institutions
    Volume V, Winter 2000

    PSA ANXIETY
    The Downside of Ultra- Sensitive Tests

    You've had the radical prostatectomy, but deep down, you're
    terrified that it didn't work. So here you are, a grown man, living
    in fear of a simple blood test, scared to death that the PSA- an
    enzyme made only by prostate cells, but all of your prostate cells
    are supposed to be gone -- will come back. Six months ago, the
    number was 0.01. This time, it was 0.02.

    You have PSA anxiety. You are not alone.

    This is the bane of the hypersensitive PSA test: Sometimes,
    there is such a thing as too much information. Daniel W Chan,
    Ph.D., is professor of pathology, oncology, urology and radiology,
    and Director of Clinical Chemistry at Hopkins. He is also an
    internationally recognized authority on biochemical tumor
    markers such as PSA, and on immunoassay tests such as the PSA
    test. This is some of what he has to say on the subject of PSA
    anxiety:

    The only thing that really matters, he says, is: "At what PSA
    levels does the concentration indicate that the patient has had a
    recurrence of cancer?" For Chan, and the scientists and
    physicians at Hopkins, the number to take seriously is 0.2nanograms/milliliter.
    "That's something we call biochemical recurrence. But even this doesn't mean that a man has symptoms
    yet. People need to understand that it might take months or even
    years before there is any clinical physical evidence."

    On a technical level, in the laboratory, Chan trusts the
    sensitivity of assays down to 0. 1, or slightly less than that. "You
    cannot reliably detect such a small amount as 0.01," he explains.
    "From day to day, the results could vary -- it could be 0.03, or
    maybe even 0.05" -- and these "analytical" variations may not
    mean a thing. "It's important that we don't assume anything or
    take action on a very low level of PSA. In routine practice,
    because of these analytical variations from day to day, if it's less
    than 0. 1, we assume it's the same as nondetectable, or zero."

  3. #3
    Experienced User eyetat's Avatar
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    This is my reading after five weeks also.
    Age 55
    PSA
    11/08-3
    12/09-3.5
    7/10-4.75
    8/1-4.6
    Gleason score 6
    lt lobe 2 of 5 C
    rt lobe 4 of 5 C
    tc2

  4. #4
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    Hi eyetat, - If by "reading" you mean that your PSA is LESS THAN 0.1 (<0.1 ng/ml), then all of my Post above, applies to you as well. Congratulations! You are both fortunate that you have such results, just 5 short weeks after your surgery. Although, technically, 6 weeks ought to be enough time for residual PSA to clear the body after surgery, there are always some exceptions to the rule and many Urologists wait for 3 months before obtaining the first post-surgical PSA test. In your cases it made no difference, while providing earlier confirmation of the anticipated and expected "undetectable" PSA - John@newPCa.org (aka) az4peaks

  5. #5
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    Many thanks for the reply. On 4/11 I get my 4th cystogram. If no leak the cath can come out.

    Question: after my cath comes out what is the risk of a stricture?

  6. #6
    Experienced User eyetat's Avatar
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    Three months after my Psa was 0.01 I now wait for a six month check up witch will be in august.
    Age 55
    PSA
    11/08-3
    12/09-3.5
    7/10-4.75
    8/1-4.6
    Gleason score 6
    lt lobe 2 of 5 C
    rt lobe 4 of 5 C
    tc2

  7. #7
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    4 months post op and my PSA is <.01.

  8. #8
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    6 months post op and my PSA is <.01

  9. #9
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    8 weeks post op and my PSA is less than 0.1.

  10. #10
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    At the age of 50, I was diagnosed with Prostate Cancer and had a Laparoscopic Radical Prostatectomy 6 months later, including Seminal Vesicles August 2010 at a NCI Cancer Center.

    First PSA ever, 3/10 -16.9 with symptoms of a UTI/Kidney Infeciton. 6 weeks later folliowing 2 rounds of antibiotics, PSA 24.6. 6 weeks prior to Surgery and after small dose oif Casodex, PSA 17

    Post prostatectomy pathology: Gleason 3+4. In Situ, Clear margins Nerve involvement in aproximately 25% required excision.

    3 month post surgical PSA at operating cancer center <.1
    6 month post surgical PSA operating cancer center <.1
    9 month post surgical PSA operating cancer center .1
    10.5 month at Quest .05
    12 month post surgical PSA operating cancer center <.1
    13.5 month at Quest .1

    Additional info:
    The 10.5 Month Quest was a PSA Post Prostatectomy, using DPC Immulite 2000 Method.
    The 13.5 Month Quest was a PSA Total, using Siemens chemiluminescent method.


    So what does this mean?

    Question 1
    The big question I can't seem to get answered is for tests that are not the "Ultra" type, do the labs use any rounding, i.e., if it is .06, does it get rounded to .1 ?

    Question 2
    With "nerve sparing" surgery techniques, is there the possibiliy that there is benign PSA from the nerves left behind?
    Answer (no thanks to this apparently dead answer board - yes, prostatic tissue that remains, especially with nerve sparing surgery does produce some PSA) In fact, a PSA between .2 and .6 is subject to watchful waiting and does not automatically mean salvage radiation is the next course of action.
    Last edited by Release; 03-14-2012 at 01:21 PM. Reason: I answered my own quetion after 6 months of no-one responding.

  11. #11
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    19 months post op and my PSA is <0.1

  12. #12
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    Quote Originally Posted by fallonboy View Post
    19 months post op and my PSA is <0.1
    Congratulations are in order ! Here's to a life of undetectable results.

  13. #13
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    Quote Originally Posted by fallonboy View Post
    19 months post op and my PSA is <0.1
    Congratulations! Success stories are always welcome and thanks for sharing.

  14. #14
    It's been 12 years since my husband had his prostate removed! The first post-op year was interesting. He was diagosed because of strictures. I suppose it depends on how long you have been cathed about strictures. We spent the first year fighting urine incontinence and were told it was to be expected. It is now a very rare occasion he has this issue. Once that was taken care of, it was back to life as usual except for sexual dysfunction. We took care of that as well. The cancer my husband had would have killed him in months. Not like the usual prostate cancer. I need to let you know there is great hope and please do not be discouraged as you walk this path. PSAs have been normal since nerve sparing surgery. I have every hope you will enjoy the same. Thinking of you.

 
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