A website to provide support for people who have or have had any type of cancer, for their caregivers and for their family members.
Page 2 of 2 FirstFirst 12
Results 11 to 16 of 16

Thread: Psa after Rp

  1. #11
    Quote Originally Posted by Southsider View Post
    In Dr. Walsh's 3rd edition of his tome on prostate cancer, he recommends against ultra sensitive PSA testing as leading to excessive anxiety.

    He hedges on this somewhat in the 4th edition, however.

    Your husband got a very favorable pathology report after his surgery. I don't think that most doctors will be very anxious to pull the trigger on salvage treatment at very low levels of PSA, as they might if he had a less favorable report.

    The problem is that you want salvage treatment or adjunctive treatment only if its necessary, as this is both expensive, and has its own side effects.

    If you do have the ultra sensitive tests, try not to get too anxious about it.
    I don't think the comment about variability in the 4th edition is correct:

    On a technical level, in the laboratory, Chan trusts the sensitivity of assays down to 0.1 ng/ml 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."
    If you look at the my Labcorp uPSA results and those of other FBs, you'll see that while there is test-to-test variation/fluctuation, it isn't usually on that large a scale. In addition, you don't have to be a genius to distinguish a definite rising trend from fluctuation.

    But I agree with the next sentence:
    "It's important that we don't assume anything or take action on a very low level of PSA."
    I'm not doubting that Dr. Chan is an international authority on immunoassays, as Walsh states, but rather perhaps (1) immunoassays have made progress and/or (2) the actual results of 3-decimal uPSA tests show a smaller variation. It has been demonstrated the Labcorp's uPSA immunoassay is very precise and accurate in ideal conditions, and it appears to be accurate or accurate enough in everyday use.

    That said, perhaps you could get day-to-day variation on a scale of 0.03 to 0.05 using a crummy 2-decimal assay.
    Last edited by DjinTonic; 06-18-2019 at 04:58 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(16): 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 check)
    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
    Avg. = 0.013

  2. #12
    Top User
    Join Date
    Aug 2016
    Posts
    1,771
    Quote Originally Posted by Honeybun078 View Post
    I don't believe he's taking any testosterone. Why would he be taking that? Is that for ED?
    Can be. Its a hormone used by men to slow the effects of aging such as; ED, libido, hair loss, muscle loss, and energy. Used by professional and amatuer body builders to boost muscle mass. It can be a substance in some prostate health medication to aid in urination symptoms or in hair loss supplements. Obese men lose the ability to produce their own testosterone and will supplement it.

    If you see a man in their 50's and 60's with a ripped physique and a full head of hair and an aggressive attitude they're probably on testosterone.

    The body reacts to and uses supplemented testosterone differently than naturally produced testosterone. It will also stop production of it's own when taken as a supplement. Little is understood about it. We know PC responds to it in different and unpredictable ways.

    Its use is best supervised by an endrocronologist and is not recommended to counter the effects of aging or imo for enhancing physique, libido, or hair loss.
    Last edited by Another; 06-18-2019 at 06:58 PM.

  3. #13
    @Another ok.

  4. #14
    Senior User
    Join Date
    Mar 2017
    Posts
    111
    As I read through the post I tended to agree and disagee with post. I for one had uPSA test at .006 for 6 consecutive 3 month test. Then .030 followed by .235 not a single variation execpt when the Pca came back. The next test continue to go up 6 days apart. So I believe the uPSA test are great indicators! I failed to see anyone post that reguardless of what the PSA is doing, insurance companies will not treat till it reaches BCR. This in its self is an issue, some doctors say .1 some .2 doesn't matter if your coverage says .xx thats when you get treated or its out of pocket at your cost! I found this out with my biopsy PSA wasn't 4.0 no biopsy. I paid myself found Pca insurance then paid when I submitted billing!
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    Pet Scan & Biopsy of rib Neg
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity multifocal
    Margins Not present on inked margins lymph nodes five negative pT3a,N0
    PSA 10/16 .1 1yr PSA 02/7/17 .4 PSA 02/15/17 .5
    Pet Scan 2//17 Neg PSA 03/17 .6 03/17 Axumin trial 17.4mm recurrence rt. semi vascular bed 03/17 Casodex + Trelstar 2yrs
    04/17 SRT (42)
    08/17 PSA <.1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/19 <.235 5/19 <3.2 6/19 <.34 7/19 <.06 8/19 <.08 9/19<.056
    7/19 Trelstar, Xtandi, Zoledronic Acid

  5. #15
    Quote Originally Posted by steve135 View Post
    As I read through the post I tended to agree and disagee with post. I for one had uPSA test at .006 for 6 consecutive 3 month test. Then .030 followed by .235 not a single variation execpt when the Pca came back. The next test continue to go up 6 days apart. So I believe the uPSA test are great indicators! I failed to see anyone post that reguardless of what the PSA is doing, insurance companies will not treat till it reaches BCR. This in its self is an issue, some doctors say .1 some .2 doesn't matter if your coverage says .xx thats when you get treated or its out of pocket at your cost! I found this out with my biopsy PSA wasn't 4.0 no biopsy. I paid myself found Pca insurance then paid when I submitted billing!
    Hi Steve! In recent years several FBs have undergone SRT at PSA levels well below BCR. Thus insurers are now allowing SRT well before PSA levels reach 0.1 or 0.2.

    See the saga of mikesimm. Mike underwent Proton Therapy SRT when his post RP uPSA only reached 0.02 ng/ml.

    https://www.cancerforums.net/threads...light=mikesimm

    0.03 ng/ml is now generally considered the best trigger point to initiate SRT with those who have high risk pathologies and a rising uPSA.

    MF
    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

  6. #16
    Quote Originally Posted by Michael F View Post
    Hi Steve! In recent years several FBs have undergone SRT at PSA levels well below BCR. Thus insurers are now allowing SRT well before PSA levels reach 0.1 or 0.2.

    See the saga of mikesimm. Mike underwent Proton Therapy SRT when his post RP uPSA only reached 0.02 ng/ml.

    https://www.cancerforums.net/threads...light=mikesimm

    0.03 ng/ml is now generally considered the best trigger point to initiate SRT with those who have high risk pathologies and a rising uPSA.

    MF
    Here is the policy from my insurance:

    Localized prostate cancer, nonmetastatic; or
    • Post-prostatectomy for dose escalation greater than or equal to 64 Gy, and at least one of the following is met:
    1. Serum prostate-specific antigen (PSA) detectable at 6 months post-op; or
    2. PSA is detectable and increases with ≤2 laboratory test results; or
    3. Post-operative staging of T3 to T4; or
    4. Post-operative pathology result documents positive surgical margins;

    I doubt they consider .02 as detectable with pT2 and negative margins.
    Last edited by Duck2; 06-19-2019 at 02:56 AM.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    3/6/19. Pathology - Grade Group 4 with Intraductal Carcinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 03 (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    3 Part Modality Treatment

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

 

Similar Threads

  1. Psa 0.04 after 4 and a half y after RP
    By Internship41 in forum Prostate Cancer Forum
    Replies: 32
    Last Post: 05-21-2019, 04:47 PM
  2. 15 Month PSA after 12 Month PSA was Detectable
    By DavefromMD in forum Prostate Cancer Forum
    Replies: 7
    Last Post: 08-23-2018, 12:28 AM
  3. Replies: 8
    Last Post: 12-10-2014, 08:16 PM
  4. Replies: 19
    Last Post: 11-16-2012, 05:57 PM
  5. Stable PSA/Free-PSA, after rise period
    By calpalmer in forum Prostate Cancer Forum
    Replies: 5
    Last Post: 04-26-2010, 01:35 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •