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Thread: Use of ultra sensitive PSA tests

  1. #1
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    Use of ultra sensitive PSA tests

    As I read many of the posts on this forum I often see reference being made to the ultra sensitive PSA tests that are available. In an effort to everything that I can to improve my odds, I've gone the route of surgery, adjuvant radiation and ADT therapy. Since surgery last June I've had two "regular" PSA tests (August and December 2016). Each have returned results of <0.1. Should I be requesting the more sensitive test in order to more closely monitor my PSA levels? I posed that question to my Urologist last fall and didn't think it was wise or necessary. In fact he thought that it would unnecessarily increase anxiety particularly in light of the fact that I've done all that I can proactively and that IF my PSA were to rise catching it below a 0.1 reading would have little value. Any thoughts on this advice? Any value in insisting on the ultra sensitive test?

    Gene
    D.O.B 4/28/57 Age: 59
    1/16 local PSA lab reading 5.4 (from 2.4 in 2015). PSA Re-test 3/16 = 5.5.
    Local uro DRE revealed no enlargement and no lumps.
    Biopsy DXd adenocarcinoma in 10/14 cores (many>80%).
    Gleason 4+3=7. Perineural invasion noted.
    CT abdomen, bone scan negative.
    DaVinci prostatectomy 6/23/16 at Florida Hospital (Celebration. FL).
    Surgeon - Dr. Vipul Patel (highly recommended).
    Nerve bundles spared: 50% of left, 75% of rt.
    Final pathology upgraded Gleason to 4+5=9 w/extraprostatic extension
    Positive margins
    Stage pT3a N0 M not known
    Decipher score = 0.82 "Genomic High Risk"
    4 lymph nodes, and seminal vesicles all negative.
    Continence - excellent
    ED - present; no function since surgery date
    Post-op exams 8/17/16: PSA <0.1
    ADT began 9/16/16: 4 month shot of Eligard, to be followed by two 1 month shots of Firmagon
    Adjuvant Radiation Therapy - 39 treatments over 8 weeks concluded 12/5/16
    PSA checkup 12/16: <0.1

  2. #2
    Gene: Like myself, u have thrown everything at this including the kitchen sink. Given that, I can understand the logic that your urologist is using. For high risk cases, I like the UPSA. But given that u have done all u can do to this point, I would agree with the uro. It probably makes little difference if your PSA started rising which test gave you that information. Best, MM
    DOB:Feb 1958
    PSA: 1/13:2.9 1/14: 4.1 3/14: 3.4 9/14: 4.4 3/15: 4.3 9/15: 5.9 PC/Father
    DRE: Normal with above tests
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Both negative
    Clinical Staging: 10/28/15 T2c
    Surgery ( RALP) UC scheduled 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    EPE; present
    Lymphovascular invasion present
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PIN
    Perineural invasion present
    Tumor location: Preipheral zone right; and left transition zone
    Tumor volume est 45%
    2 positive margins of 4 ( Periphera and distal)
    Staging: pT3bNO
    UPSA: 2/9/16 0.05
    UPSA: 3/23/16 0.11
    Casodex: 4/1/16- 8/5/16
    Lupron: 4/15/16... 12 months, as of now
    SRT: 6/14/16...8/5/16 38 treatments completed
    8/10/16. UPSA <0.05
    11/18/16 UPSA <0.05
    2/8/17 UPSA <0.05

  3. #3
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    Hi Gene! First, Congrats on your recent PSA!

    Dr Patel is an extremely experienced Uro surgeon and you should gladly follow his advice. uPSA can be a major source of tremendous "PSA Anxiety!" So why subject yourself needlessly?

    IMO, uPSA is indicated for high risk post RP patients as a means to detect imminent BR as early as possible. You are well beyond that having now completed AR.

    Also, since you are still on ADT, a uPSA at this time will have no added clinical value vs a standard PSA.

    Be very pleased and content with your 12/16: <0.1 May it remain <0.1 permanently!

    Best of luck.

    MF
    Last edited by Michael F; 01-12-2017 at 03:57 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = Gleason 7 (3+4) and 5 = Gleason 6
    March '12: Robotic RP: Left Positive Margins + EPEs. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3A pNO pMX pRO / Prostate Size = 32 grams; Tumor = Bilateral; 20% / Perineural invasion: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml uPSA remains: = 0.020 ng/ml "Mean (+/-) STD" = 0.002 At 54 Months Post Op: (14 uPSAs: Range 0.017 - 0.024) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 98%)
    ED = present

  4. #4
    Top User Jim215's Avatar
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    I love MichiganMan16.
    I love Michael F.

    But I must respectfully disagree on the subject of PSA possibly causing "anxiety", so let's just stay uninformed instead.
    As noted in the past, my knowledge of a PSA "creeping" up helped me to mentally deal with the need for salvage radiation when it came time to be zapped.

    As an old guy, I lean toward using analogies -- try this one:
    You live in Florida. You have a small inflatable pool in the back yard filled with 12 inches of water. Your 18-month-old grandchild is playing and splashing in the pool. You walk back into the house for just a few seconds. As you do, an alligator leaves a nearby swamp and heads for the pool.

    Question: Do you want to be alerted when the alligator is 100 yards away from the pool or just 2 yards away? Would you NOT want to know when it's 100 yards away because it may cause you "anxiety"?

    Jim
    LUNG
    Age: 71 -- 12/2013 - Cat Scan sees new irregular 1.8 cm nodule in right middle lobe.
    3/13/14 - PET Cat Scan confirms presence of same nodule -- same size. Nodule lights up indicating likelihood of lung cancer -- Location not conducive to biopsy.
    3/17/14 - Three top doctors say it MUST come out via a wedge re-section. If cancerous, the entire right middle lobe must be surgically removed.
    6/13/14 - Nodule shrank by 1/3. Not cancer. Surgery cancelled. Next scan 9/14. Nodule "resolved" - gone.

    PROSTATE
    Age: 67 -- 2/2010 - PSA: 4.05
    8/2010 - PSA: 4.95
    9/2010 - Biopsy - 2 out of 12 cores positive - Gleason: 3+4=7
    11/8/2010 - DaVinci RALP - small positive margin - was told it was meaningless.
    2/11 - PSA: 0.02; 8/11 - PSA: 0.04; 2/12 - PSA: 0.06; 8/12 - PSA: 0.08; 2/13 - PSA: 0.11; 5/13 - PSA: 0.16 - referred to oncology radiologist.
    9/2013: 40 sessions of IMRT salvage radiation completed.
    1/14, 4/14, 7/14, 10/14, 1/15, 8/15, 3/16, 8/16 - All PSA: 0.00

  5. #5
    Jim215: As you know, u are my favorite on this forum. We are on the same page. My comments were not based on someone having PSA "anxiety". Pardon my straight talk. I think the entire PSA "anxiety" thing is way overrated. So we all have anxiety? Is that going to change the issue? Our numbers are what they are. No amount of "anxiety" or worry will change that. My comments to Gene were based on what he has already done in terms of his treatment. Like myself, it has been damn the torpedoes. If his PSA starts to rise from here, it will make little difference if he finds out at .1 or.2 or.3 etc. Both Gene and I, to just tell it like it is, are basically out of curative options. Talking about Gene, I am talking about myself. Unless there is something else out there I am not aware of. If my PSA starts to rise, I will probably be on HT for the rest of my life. Or as my RO says, it's her job to keep me alive for the next 10-15 years, then benefit from the new drugs and treatments that are in the pipeline.

    Neither Gene nor I know if we are cured, but a UPSA vs. a standard one is not going to make a difference in terms of HT/ADT starting etc. Hope I am making some sense. Hope u are doing well, always a pleasure to hear from u.

    Nobody gives the analogies better than u!

    You got to know when to hold, when to fold, when to walk away, when to run...... Geez, I think u know all that!! Best, MM
    DOB:Feb 1958
    PSA: 1/13:2.9 1/14: 4.1 3/14: 3.4 9/14: 4.4 3/15: 4.3 9/15: 5.9 PC/Father
    DRE: Normal with above tests
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Both negative
    Clinical Staging: 10/28/15 T2c
    Surgery ( RALP) UC scheduled 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    EPE; present
    Lymphovascular invasion present
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PIN
    Perineural invasion present
    Tumor location: Preipheral zone right; and left transition zone
    Tumor volume est 45%
    2 positive margins of 4 ( Periphera and distal)
    Staging: pT3bNO
    UPSA: 2/9/16 0.05
    UPSA: 3/23/16 0.11
    Casodex: 4/1/16- 8/5/16
    Lupron: 4/15/16... 12 months, as of now
    SRT: 6/14/16...8/5/16 38 treatments completed
    8/10/16. UPSA <0.05
    11/18/16 UPSA <0.05
    2/8/17 UPSA <0.05

  6. #6
    Top User Jim215's Avatar
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    MM16:

    My bad. I think my position on PSA is valid in more than 95% of post-surgery cases.

    But you're right. Not in Gene's case or yours.

    I apologize.

    Jim
    LUNG
    Age: 71 -- 12/2013 - Cat Scan sees new irregular 1.8 cm nodule in right middle lobe.
    3/13/14 - PET Cat Scan confirms presence of same nodule -- same size. Nodule lights up indicating likelihood of lung cancer -- Location not conducive to biopsy.
    3/17/14 - Three top doctors say it MUST come out via a wedge re-section. If cancerous, the entire right middle lobe must be surgically removed.
    6/13/14 - Nodule shrank by 1/3. Not cancer. Surgery cancelled. Next scan 9/14. Nodule "resolved" - gone.

    PROSTATE
    Age: 67 -- 2/2010 - PSA: 4.05
    8/2010 - PSA: 4.95
    9/2010 - Biopsy - 2 out of 12 cores positive - Gleason: 3+4=7
    11/8/2010 - DaVinci RALP - small positive margin - was told it was meaningless.
    2/11 - PSA: 0.02; 8/11 - PSA: 0.04; 2/12 - PSA: 0.06; 8/12 - PSA: 0.08; 2/13 - PSA: 0.11; 5/13 - PSA: 0.16 - referred to oncology radiologist.
    9/2013: 40 sessions of IMRT salvage radiation completed.
    1/14, 4/14, 7/14, 10/14, 1/15, 8/15, 3/16, 8/16 - All PSA: 0.00

  7. #7
    Moderator Top User HighlanderCFH's Avatar
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    Quote Originally Posted by GeneShue View Post
    As I read many of the posts on this forum I often see reference being made to the ultra sensitive PSA tests that are available. In an effort to everything that I can to improve my odds, I've gone the route of surgery, adjuvant radiation and ADT therapy. Since surgery last June I've had two "regular" PSA tests (August and December 2016). Each have returned results of <0.1. Should I be requesting the more sensitive test in order to more closely monitor my PSA levels? I posed that question to my Urologist last fall and didn't think it was wise or necessary. In fact he thought that it would unnecessarily increase anxiety particularly in light of the fact that I've done all that I can proactively and that IF my PSA were to rise catching it below a 0.1 reading would have little value. Any thoughts on this advice? Any value in insisting on the ultra sensitive test?

    Gene

    For whatever this might matter, as a point of observation: Mayo Clinic does not make much use of the uPSA for the reasons listed up above -- it can cause far too much unnecessary anxiety.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Five annual post-op exams 2012 through 2016: PSA <0.1
    Semi-firm erections 5 years post-op whenever the moon turns blue.

  8. #8
    Jim: You are the last person who ever has to say they are sorry to me. I was just presenting a point of view of the high risk cases that have gone thru multiple treatment options.

    You are correct, in 85-95 percent of the cases, I would be using your logic. Here's to hoping all of us never have to deal with a rising PSA. Btw...it's never your bad! You're a great guy. Best, MM

  9. #9
    I'd rather know sooner than later of any trend and want to decide for myself what may or may not create anxiety.
    Year of birth: 1951
    PSA summer 2014 4.2
    PSA fall 2014 4.4
    Biopsy fall 2014, Gleason 3+3
    Decided on RALP fall 2014
    RALP U of Penn, Thomas Guzzo Feb 2015, both nerve bundles spared.
    Pathology after surgery Gleason 3+4, 10% of Prostate, contained within prostate
    PSA May 2015 <0.1

  10. #10
    Newbie New User
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    I've too have exhausted my curative options, so the uPsa is probably no longer needed. But my uro still uses it. And I also would prefer to decide for myself whether or not to have anxiety. For those of us who've had adverse pathology factors after surgery, i.e. positive margins, high volume involvement, EPE, LN, etc. the likelihood of needing additional treatment is much higher. The uPsa helps to establish earlier whether there is an upward trend. Earlier response with secondary treatment seems to have better results, (I've been told). But after SRT, there probably isn't any benefit to using a uPsa for a regular test.
    YOB 1957, Age at Dx 57. Pre-surgery psa 5.9, 5-27-2014 RP, T2c, 2 G7 (3+4), 4 G6 (3+3). 50% involved. Prostate 28g. +2 margins (lateral, apical). Post surgery psa <.006, 19 month psa 0.023 on 12-16-16.
    70gy/35 SRT finished 2-16. 3 month Post SRT Psa on 4-16-16 0.02 (no change). 6 month Post SRT Psa on 8-8-16 0.009. 9 month Post SRT Psa on 11-12-16 .006.

 

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