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Thread: After almost six years... Not a Zero

  1. #61
    Quote Originally Posted by ddayglo View Post
    New uPSA: 0.09

    I've graduated to three month retest.
    Excellent. The more years that pass since your pT2 RP, the even lower your chance of BCR become.

    A question: Were your two readings before this last of 0.09 single-decimal (0.1) or two-decimal (0.10)? In other words, did you have a different test? Are you getting the actual lab reports or transcribed or communicated results?

    Assuming your past "undetectable" results were reported as <0.1, you don't know if the actual values were much lower or if they were near 0.1. Consequently, your PSA may have been very stable since your RP or not. I suggest testing to two decimal places going forward and getting your actual lab reports (some folks responsible for transcribing data are not familiar with reporting significant digits).

    Djin
    Last edited by DjinTonic; 11-19-2019 at 06:58 PM.

  2. #62
    Top User garyi's Avatar
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    Quote Originally Posted by DjinTonic View Post
    Excellent. The more years that pass since your pT2 RP, the even lower your chance of BCR become.

    A question: Were your two readings before this last of 0.09 single decimal (0.1) or two-decimal (0.10)?

    Djin
    A most important question.

    Note from my recent uPSA's below, they are all from the same lab....
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19, .116 11/19
    We'll see....what is not known dwarfs what is thought to be fact

  3. #63
    Quote Originally Posted by ddayglo View Post
    New uPSA: 0.09

    I've graduated to three month retest.
    Hi ddayglo! Excellent! Although this is not a precipitous drop from your previous 3 results, it is NOT BCR which is far better than your recent ".1" results!

    You can stay off of The SRT Table!!!

    Dj is likely correct that your PSA may have been just below 0.1 following RP and subsequently either reported as "Undetectable" or rounded up to ".1". Of course you would have known this had you requested copies of each original lab report along the way!!!

    So, with this new result, What can you tell us about it?

    - Do you have a copy of The Original Lab Report?

    - Where/What Lab analyzed the blood?

    - What PSA Methodology was used?

    Be sure to continue using The Same Lab and Same PSA Methodology Every Time!

    Very glad that this result supports that BCR has not been "achieved!"

    Good luck in 3 months and beyond for permanent < 0.10!

    MF
    Last edited by Michael F; 11-19-2019 at 05:33 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. 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 c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  4. #64
    The previous uPSA tests were all 0.10
    Now it's a 0.09.

    I was told that the lab used for standard tests is sensitive down to 0.07.

    I'm glad that I insisted on having PSA every six months instead of annually. I wish I had asked for the uPSA instead of the standard ones all along at least once a year, but that's water under the bridge...

  5. #65
    Quote Originally Posted by ddayglo View Post
    The previous uPSA tests were all 0.10
    Now it's a 0.09.

    I was told that the lab used for standard tests is sensitive down to 0.07.

    I'm glad that I insisted on having PSA every six months instead of annually. I wish I had asked for the uPSA instead of the standard ones all along at least once a year, but that's water under the bridge...
    When someone, especially low-risk, is followed with a standard test and remains <0.1 for life, the question of their actual PSA numbers and trend is not important and rarely comes up. But once the less-than sign drops off, questions arise. And the next rise with the standard test is, of course, 0.2. Tracking your PSA with an ultrasensitive test is not a commitment to undergo treatment at a very low level; it simply provides better tracking, a more accurate calculation of velocity if your PSA does rise, and more lead time to prepare an investigation or treament if necessary.

    Djin
    Last edited by DjinTonic; 11-19-2019 at 08:15 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day retest)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    12-18-19 (24 m)
    Avg. = 0.013

  6. #66
    Quote Originally Posted by DjinTonic View Post
    When someone, especially low-risk, is followed with a standard test and remains <0.1 for life, the question of their actual PSA numbers and trend is not important and rarely comes up. But once the less-than sign drops off, questions arise. And the next rise with the standard test is, of course, 0.2. Tracking your PSA with an ultrasensitive test is not a commitment to undergo treatment at a very low level; it simply provides better tracking, a more accurate calculation of velocity if your PSA does rise, and more lead time to prepare an investigation or treament if necessary.

    Djin
    Yup, strong agree. Thanks.

  7. #67
    Quote Originally Posted by ddayglo View Post
    The previous uPSA tests were all 0.10
    Now it's a 0.09.

    I was told that the lab used for standard tests is sensitive down to 0.07.

    I'm glad that I insisted on having PSA every six months instead of annually. I wish I had asked for the uPSA instead of the standard ones all along at least once a year, but that's water under the bridge...
    ddayglo: You still did not answer and have never answered, any of the 3 questions in Post # 63?!?!? Please don't feel like I am picking on you (but I am - slightly!) However, I try to emphasize some important issues about monitoring for BCR and will now use you as an example. So please don't be offended. It is for the greater good of Forum members & visitors!

    Specific to you:

    - Using "0.1" to define BCR, means you are knocking on the door - which hopefully will never open!

    - You remain either uninterested or clueless about your PSA tests (see your above statement highlighted in red) But this is fine because:

    - Your Surgical and Path findings do not place you in a High Risk for recurrence category.

    So I am taking you off the hook but using you as an example!


    I am aiming at those who are in an elevated risk for recurrence category and are monitoring for BCR via uPSA testing. It is very important to take control of your PSA monitoring by learning and understanding the basics. Most MDs do not understand these details.

    The objective is to detect a clinically rising PSA as early as possible in order to take immediate corrective action.

    - Learn & Confirm: Where/Which Lab analyzes the blood sample each time?

    - What uPSA Methodology is used?

    - Get & Keep a copy of The Original Lab Report each time?

    - It is essential Use The Same Lab and Same PSA Methodology Every Time! Otherwise, results can NOT be compared.

    - Errors can and do occur!


    Lastly, Remain Vigilant! Now this includes ddayglo!

    MF
    Last edited by Michael F; 11-20-2019 at 04:07 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. 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 c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  8. #68
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    I'll go further and suggest you begin mapping out your next level of treatment. I'd suggest you meet with a RO and MO and determine your next steps. You want to stay ahead of this, not behind it.

    Early detection early treatment all the way down. Be prepared. You've already had two 0.1 tests. It is not going away, nor will it decline, imo. Take advantage of your yellow flag and engage the next level of experts.

    There are those who argue, and with merit, any two reliable increases constitutes BCR at any significant level. After a successful RP your PSA is hypothetically supposed to be close to zero in the thousands and hundreds. Yours is now well above that and has been for a while. By not using a lower level sensitive test you are still unaware of its velocity.

    If indeed you are not recommended/eligible for the next level of treatment I suggest you hear it form those responsible for providing that level of treatment. They are your experts now.

    I see no relief for you in wating another three months to confirm what you already know. I see no practicle difference in a 0.09 and a 0.1. This disease has no regard for splitting hairs.
    Last edited by Another; 11-20-2019 at 03:11 PM.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronies
    Erections 100% - 14 months
    12-08-19 PSA <0.02, Zero Club 3.5 years

  9. #69
    - Do you have a copy of The Original Lab Report?
    I do not, but it was taken after six weeks, "standard PSA" test, Quest Lab, undetectable.

    - Where/What Lab analyzed the blood?
    It's been Quest all along for the standard test. I will keep going to the same group for the uPSA tests.

    - What PSA Methodology was used?
    all along, from six weeks until this year, was the "standard PSA". Once it came back .1, I switched (forever) to the uPSA.

    I am going to be tested in less than three months, and plan on staying on a three-month plan for all of 2020 (irregardless of what my surgeon recommends). My trigger is anything above a .10. If it does, then I will dive deep into treatment options if the PSA goes above that.
    BD: 1959 PSA 4.9 11/2012 (no symptoms)
    Biopsy 12/2012 Negative
    PSA 5.9 05/2013 (still no symptoms)
    Biopsy 6/2013 3+4 (thank goodness for PSA tests)
    1 core positive (upper left), 1 suspicious (lower left) out of 12
    DRE: bump right side T1c; PCA-III = 20 (normal)

    Da Vinci 7/18/2013: Invasive carcinoma involves left lobe of prostate only, extends from left apex to posterior mid region of left lobe Gleason 7/10 (4+3); G4 tumor comprises 75% of invasive carcinoma present
    Estimated total volume of carcinoma in entire prostate gland: 10%
    TNM: T2b NX MX (Stage IIA)

    8/13 11/13 2/14 8/14 2/15 8/15 3/16, 8/16, 3/17,9/17,4/18, 9/18 PSA undetectable
    3/19: .1 (damn), 4/19,6/29 retests: .1 (damn)


    My Story:
    T-Minus-36-Hours-until-da-Vinci...
    Catheter is Out!

 

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