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. biopsies, PCA3 -
    2013 TURP (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 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: negative

    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. 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 checking rise
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  2. #12
    Top User
    Join Date
    Aug 2016
    Posts
    1,536
    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
    Experienced User
    Join Date
    Mar 2017
    Posts
    98
    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!
    Diagnosis 56: DOB 2/59 PSA 01/14 (2.0) 6/15/15 (2.4)
    Biopsy 6/23/15 5 positive very aggressive Gleason Score 8
    Bone Pet Scan & Biopsy of rib Neg
    Radical da Vinci 10/15/15
    Pathology 54g 5x4.2x2.8cm gleason's grade 4+3=7 Tumor location quadrants Bilateral
    Extent of local invasion: Extra-capsular extensions present,Semi vesicles no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity : multifocal
    Margins involvement/Not present on inked margins lymph nodes : five negative Pathologic stage pT3a,N0
    PSA 10/6/16 .1 1yr PSA 02/02/17 .4 PSA 02/15/17 .5
    Pet Bone Scan 2/18/17 Neg
    PSA 03/08/17 .6
    03/17/17 Axumin trial 17.4mm recurrence rt. semi vascular bed
    03/29/17 Casodex + Triptorelin Pamoate Injections 2yrs Casodex 6/18
    04/03/17 SRT (42) completed 6/3/17
    08/31/2017 PSA < .1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/17/19 <.235 5/24/19 <.258
    06/10/2019 Pet w/Axumin inconclusive. Xtandi started say on Trelstar waiting xgeva in Aug.

  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 = Gleason 7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    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 "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  6. #16
    Senior User
    Join Date
    Jan 2019
    Posts
    389
    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.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    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, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    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. 38% risk 5 year metastasis.

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

    ADT started 6/3/2019

 

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
  •