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Thread: Psa Frequency

  1. #11
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    The only reason I can see to be more diligent, and I think they are good ones, is his young age and his volume at his young age. The next hurdle is his next PSA test. While post RP pathology is highly accurate for +margins and EPE (in the high 95+%) there is a sightly higher risk of missing Gleason upgrading. The prostate is sliced and examined internally to a statistically acceptable level of inspection, but not a 100% certainty or as high as the external examination.

    Not trying to be a doom and gloomer here. Your husband's report is about as good as you can ask for considering his age as the outlier. Just giving you the facts which is why you are here. Cancer knowledge is a statistical game. You can play the odds when it's cash you're betting. It's a different game when it's your health. Your health is a limited resource and winning doesn't replenish the reserve. There is only losing if you're the 1 in 10.
    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 Peyronie’s
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  2. #12
    I get that as far as sometimes they miss higher grades but that percentage is very low it happens on final path... With the no adverse findings and thers only being 10% involvement was a big plus. I definitely want to stay on top anf be ahead as much as we can but I also don't want to live our life with a constant worry or searching for something that's not there. My concern also is even if the grade was missed, the margin, sv and all was negative. So there's that factor. I do think I want to be on 6 mths for at least 3 years. Just for my satisfaction but I was concerned when others said don't ever change to yearly.

  3. #13
    When I asked my uro/surgeon when we could stop monitoring my PSA his reply was "Never." He has seen PCa cases recur after 20, 25 years. That said, this topic has been studied. From our SubForum, Topic (K):

    Determining When to Stop Prostate Specific Antigen Monitoring after Radical Prostatectomy: the Role of Ultrasensitive Prostate Specific Antigen [2017]

    Abstract

    Purpose
    We analyzed long-term followup data after radical prostatectomy to determine how long we should follow patients in whom the serum prostate specific antigen level measured by an ultrasensitive assay was consistently low.

    Materials and Methods
    We retrospectively reviewed clinicopathological data for 582 consecutive patients who underwent open or laparoscopic radical prostatectomy between 1995 and 2004, excluding 4 patients who received adjuvant therapy. We stratified the patients according to prostate specific antigen at 3 and 5 years after surgery, and examined subsequent biochemical recurrence (elevation of prostate specific antigen to greater than 0.2 ng/ml) during followup. Mean followup was 9.7 years.

    Results
    At 3 years after surgery prostate specific antigen levels were measured by an ultrasensitive assay in 323 patients who had not experienced biochemical recurrence. In 187 patients with undetectable prostate specific antigen levels (less than 0.01 ng/ml) the 10 and 15-year biochemical recurrence-free survival rates were 99% and 96%, respectively. At 5 years after surgery prostate specific antigen was measured in 315 patients by the ultrasensitive assay. In 162 patients with undetectable prostate specific antigen levels the 10 and 15-year biochemical recurrence-free survival rates were both 100%. In this group the prostate specific antigen level at last followup was less than 0.01 ng/ml in 132 patients, 0.01 to 0.03 ng/ml in 27 patients, and 0.06 ng/ml, 0.07 ng/ml and 0.11 ng/ml in 1 patient each.

    Conclusions
    This long-term review indicates that if patients have continuously undetectable prostate specific antigen levels by an ultrasensitive assay for 5 years, prostate specific antigen monitoring can be stopped with an extremely low risk of subsequent biochemical recurrence.
    [Emphasis mine]

    "Extremely low" doesn't quite cut it if you're in that group! Also, avg. follow-up was only about 10 years!


    Prostate Specific Antigen Testing after Radical Prostatectomy—Can We Stop at 20 Years? [2018]

    Purpose
    We examined the clinical features and outcomes associated with delayed biochemical recurrence after radical prostatectomy, specifically among men with more than 20 years of followup.

    Materials and Methods
    A total of 16,720 men underwent radical prostatectomy and 2,699 experienced biochemical recurrence. We determined predictors of delayed biochemical recurrence as well as metastasis-free and cancer specific survival rates for recurrence at various time points after radical prostatectomy. We performed subset analysis of the 732 men with 20 or more years of recurrence-free followup. Cumulative incidence curves for metastasis and prostate cancer death were calculated and stratified by biochemical recurrence time points.

    Results
    Predictors of delayed biochemical recurrence included elevated prostate specific antigen at radical prostatectomy, higher clinical and pathological stage, and positive surgical margins. Delayed biochemical recurrence was associated with favorable cumulative incidence curves for metastasis and prostate cancer death compared to early biochemical recurrence. Among the 732 men with undetectable prostate specific antigen at 20 years biochemical recurrence developed in 17 (2.3%), metastatic disease developed in a single patient and none died of prostate cancer. The actuarial probability of biochemical recurrence among men with undetectable prostate specific antigen at 20 years increased with adverse pathological features.

    Conclusions
    Men with delayed biochemical recurrence have favorable clinical features and improved survival. Men with undetectable prostate specific antigen 20 years after radical prostatectomy had a low rate of recurrence and no deaths from prostate cancer. This suggests that 20 years is a reasonable time to discontinue prostate specific antigen testing.
    [Emphasis mine]

    I think you could make a case for increasingly longer times between tests after X or Y years, but we get so many blood tests regularly anyway -- what is one more? I fail to see much logic in stopping entirely--we're not talking about an invasive procedure or an inconvenient non-invasive one.

    Of course testing has a different importance if you are age 50 and your treatment was a year ago, or you are 87 and your treatment was 37 years ago. If you're old enough, you can also consider the average number of years for clinical recurrence to develop after BCR, if it does at all.
    Last edited by DjinTonic; 07-19-2019 at 04:13 PM.

  4. #14
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    1,692
    I've shared before, my plan is to switch to annually at 5 years. My path was okay, but not as good as yours. I'm older and will be 70 then.

    3 years is a good plan, and you can always change a plan. It is not uncommon for recurrence to show up many years out. So, always keep testing at some interval till it really doesn't matter any more.
    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 Peyronie’s
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  5. #15
    After over five years of all zeros, my PSA inched up.... So I am very glad I decided on a 6-month testing schedule. So it was detected earlier...

    All I did was schedule my annual physical and surgeon visit six months apart and have PSA drawn for both.

  6. #16
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    Quote Originally Posted by ddayglo View Post
    After over five years of all zeros, my PSA inched up.... So I am very glad I decided on a 6-month testing schedule. So it was detected earlier...

    All I did was schedule my annual physical and surgeon visit six months apart and have PSA drawn for both.
    This makes a useful point. ddayglo's PSA was rising for the last five years and just crossed the detection limit of the test he uses.

    Annual vs 6 month testing is not as critical a choice if the plan is not to act before 0.1. This is the distinction between early detection early treatment and the 0.1 detection treatment protocol for second tier treatments.

    ddayglo got a <6 month "early warning" by choosing a 6 mo schedule vs an annual schedule with a <0.1 limit test. Any of the uPSA test limits available may have given him a warning of years compared to his <6 month warning. If his plan was always to act after 0.1 then annual testing works, imo. The <0.1 testing limit is for treatment plans designed for treatment post 0.1, not before. Early waring is first done by a more sensitive test then by a shorter test interval.

    The argument to be made by the healthcare system is his 5 or 6 extra tests probably cost the system $600 - 700 dollars. While this seems low, significant cost savings are made by managing the nickels and dimes.

    I was once considering a life risking medical test with a following choice of a life risking treatment. The doctor refused to perform the test without my commitment to proceed with treatment. He said I can change my mind after the test and refuse treatment then, but he will not proceed with the test without my commitment to the treatment at the time of the test. I understood. I considered it carefully, developed a plan, and agreed to the test. Doctors concern themselves with health risks while not swo much with cost. If I had been ddayglo' s doctor I would have agreed to 6 month testing after the first 3 uPSA only if he had a plan to support it based on earlier detection whether he ultimately executed the plan or not. And, not if he was using a <0.1 test from the start with no plan to act sooner. He would have gotten three 6 month tests then switched to annually. I am assuming he got the test because he committed to a treatment plan if it hit 0.1.

    These are difficult conversations and deserve being had sooner rather than later. Giving someone a test they have no commitment to acting on is a waste, imo. At best, you may hope a change in test results may percipitate a change in treatment commitment. There is more to healthcare than randomly and arbitrarily testing for it. At the time, did ddayglo have an understanding and choice in the test limit he was being given and it's impact on his treatment choices?

    In reality, nobody can claim zero PSA unless a test can detect zero PSA. It is accurate to call it the <0.1 nondetectable club, or <0.02 nondetectable club, or <0.06 nondetectable club, or whatever your test detection limit is.

    Phrases like zero club, cure, and cancer free are evidence of denial in our language. They probably don't exist in the breast cancer world. Men.

    Today, dadayglo's advice from me on this forum is a 55 year old man with G4 is served well by uPSA testing and consulting with an RO as soon as he exceeds 0.02. I consider that early warning. I laso want the specific data of that increase. When did it start? How quickly is it increasing? Body scans are next and I would have wanted those baselines to have been sooner.

    PS: the end of the story about the life risking test and treatment is I had the test and then the treatment. The treatment killed me.

    PPS: not personal ddayglo. In my world, we are all here to be examples for those coming behind us.
    Last edited by Another; 07-21-2019 at 05:39 PM.

  7. #17
    Quote Originally Posted by Another View Post
    This makes a useful point. ddayglo's PSA was rising for the last five years and just crossed the detection limit of the test he uses.

    Annual vs 6 month testing is not as critical a choice if the plan is not to act before 0.1. This is the distinction between early detection early treatment and the 0.1 detection treatment protocol for second tier treatments.

    ddayglo got a <6 month "early warning" by choosing a 6 mo schedule vs an annual schedule with a <0.1 limit test. Any of the uPSA test limits available may have given him a warning of years compared to his <6 month warning. If his plan was always to act after 0.1 then annual testing works, imo. The <0.1 testing limit is for treatment plans designed for treatment post 0.1, not before. Early waring is first done by a more sensitive test then by a shorter test interval.


    Today, dadayglo's advice from me on this forum is a 55 year old man with G4 is served well by uPSA testing and consulting with an RO as soon as he exceeds 0.02. I consider that early warning. I laso want the specific data of that increase. When did it start? How quickly is it increasing? Body scans are next and I would have wanted those baselines to have been sooner.

    PS: the end of the story about the life risking test and treatment is I had the test and then the treatment. The treatment killed me.

    PPS: not personal ddayglo. In my world, we are all here to be examples for those coming behind us.
    Interesting thread...

    - see this thread (https://www.cancerforums.net/threads...ars-Not-a-Zero) for more info about my rise in PSA...

    The tests I've been taking (same lab, same surgeon) detect down to .064.

    I'm glad that I tested every six months instead of annually, as it did give me up to a six month "head start" on the increased monitoring and would highly recommend it to everyone, standard or uPSA testing.

    But of course in hindsight a uPSA test every six months would have been preferable.

    I'm going to ask to switch to the uPSA test on my next call with my surgeon. Hopefully my insurance will cover it like it's been covering the standard PSA tests.
    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!

  8. #18
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    Confusing to say the least

    What you describe sounds more like you lost your< sign on a <0.1 test. Your lab has the ability to provide ultrasensitive testing, but you are not testing with the uPSA test, but instead with a <.1 test.

    If what all you said is true, a jump from <.06 to .1 in 6 months after 5 years of no movement seems unusal.

    When do you plan on sorting this out? I'd like to know.
    Last edited by Another; 07-21-2019 at 08:36 PM.

  9. #19
    Ddayglo. Perhaps I missed something. Your say the 3-decimal test PSA used has a lower limit of detection of 0.064 (higher than other 3-decimal uPSA tests we've seen in the Forum, but that's not important). Your past tests were all "undetectable," which means they were all necessarily <0.064. Why were your last higher test and retest reported as 0.1, with a single decimal place? Or are you doing the rounding yourself? This isn't just an academic question if you are trying to determine whether your PSA is now rising.

    Are you seeing original lab reports or values that have been transcribed into another portal or into summary reports?

    Djin
    Last edited by DjinTonic; 07-22-2019 at 02:31 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    7-05-13 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 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

  10. #20
    Why would any doctor want a 3 decimal result with a LLD of .064?
    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 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.

    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)

    ADT - 6/3/19
    ART - 8/5/19

 

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