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Thread: Is there a newer definition of "undetectable PSA"

  1. #11
    Quote Originally Posted by Duck2 View Post
    I am going to have to disagree with that statement. Most hospital labs do not test down to .01. Most the well known cancer centers of excellence do not test down to <.01.
    To clarify 3 points:

    1. "Most hospital labs do not test down to .01" = True. Those of us utilizing a 3 decimal uPSA are not being tested/analyzed by hospital labs.

    2. "Most URO Surgeons are looking for < 0.01 ng/ml at 12 weeks as a general rule." This came from my URO Surgeon and several others with who I have had this discussion and not from published any clinical data. My "guess" is from the Surgeon's perspective, this indicates a very good surgical result.

    3. "Clinically Undetectable = < 0.05 ng/ml" Emory Univ developed the Axumin Scan tracer. 5 months post RP, I went to investigate/enroll in an Axumin / SRT Clinical Trial (ClinicalTrials.gov Identifier: NCT01666808 ) and had several meetings with the PI, A Jani, MD. I was excluded because my PSA (tested at Emory) was < 0.05 ng/ml. Dr J explained that this was the accepted level for clinical (un)detectability. This was 7 years ago.

    Since several of the premier PCa Programs, such as The Mayo Clinic, do not utilize uPSA testing begs the question: "Why should/do we?"

    MF

  2. #12
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    Medicine is a conservative profession in science. The larger and more prestigious the institution the more conservative it is. The "premier" institutuons will be the last to change their protocols. This is an intentional practise on their part to serve as the baseline.

    This is separate and apart from their components who research and develop.

  3. #13
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    Quote Originally Posted by Michael F View Post
    To clarify 3 points:

    1. "Most hospital labs do not test down to .01" = True. Those of us utilizing a 3 decimal uPSA are not being tested/analyzed by hospital labs.

    2. "Most URO Surgeons are looking for < 0.01 ng/ml at 12 weeks as a general rule." This came from my URO Surgeon and several others with who I have had this discussion and not from published any clinical data. My "guess" is from the Surgeon's perspective, this indicates a very good surgical result.

    3. "Clinically Undetectable = < 0.05 ng/ml" Emory Univ developed the Axumin Scan tracer. 5 months post RP, I went to investigate/enroll in an Axumin / SRT Clinical Trial (ClinicalTrials.gov Identifier: NCT01666808 ) and had several meetings with the PI, A Jani, MD. I was excluded because my PSA (tested at Emory) was < 0.05 ng/ml. Dr J explained that this was the accepted level for clinical (un)detectability. This was 7 years ago.

    Since several of the premier PCa Programs, such as The Mayo Clinic, do not utilize uPSA testing begs the question: "Why should/do we?"

    MF
    Michael,

    My gut feeling is most doctors are looking for PSA trends regardless as to whether you are getting tested at the 0.0, 0.00 or 0.000 levels. I doubt anyone is going to make a treatment decision based on what's happening in the third decimal place. So, to your point, why not just use 0.00 testing? In my case, I'm definitely more interested in whether my PSA will trend from 0.01 to 0.03 than from 0.010 to 0.015. Brothers at higher PSA levels, say 0.1 and above certainly have zero interest regards what's happening in the third decimal place.

    I'm not saying I'm not going to fret some if my uPSA go up slightly - I will - but only for the following 3 months.

    Also, I had my prostatectomy done at Indiana University Health - which is a research hospital. They routinely use uPSA testing. I'm not sure why other - more prestigious - research institutions like Mayo or JH don't use it routinely.
    DOB: 10/1962

    6-01-15 PSA 2.5
    Having urination flow issue in first half of 2018. Flomax 6/1-6/21 - no help.
    6/25/18 PSA 14.25; Cipro 14 days
    8/1/18 PSA 17.44; rec. Urologist appt
    8/15/19 First Uro appt. + for bacteria. Cipro 4 weeks
    10/2/19 PSA 22.4; Still + for bacteria. Antibiotics 4 more weeks
    12/28/19 PSA 27.5
    1/15/20 Biopsy results 6/12 cores positive - all left side; GS 4+3
    1/18/19 Bone scan and CT scan both negative
    2/15/19 Di Vinci RP
    2/18/19 Path report pT3a, GS 4+3 (60%+35%) 5% GS5, SM +, EPE +; LVI -, SVI -, LNI(9) - ; Tumor size: 3.5cmx3.5cmx1.5cm (yikes); single foci left side; right side nerves spared; SM+ at apex limited <1mm; benign prostatic cells noted at spared right nerve bundle margin. Prostate size 45gm.
    Cath out at 7 days: 100% continent with some ED; ok with 10mg Cialis.
    Decipher 0.73 - 5-year Metastasis risk 19%; 10-year PCSM 13%.

    PostOp PSA testing:
    3/26/19 (6 weeks) 0.033
    5/10/19 (3 months) 0.010
    8/02/19 (6 months) 0.019

  4. #14
    Quote Originally Posted by Another View Post
    Medicine is a conservative profession in science. The larger and more prestigious the institution the more conservative it is. The "premier" institutuons will be the last to change their protocols. This is an intentional practise on their part to serve as the baseline.

    This is separate and apart from their components who research and develop.
    At the hospital level, pressure to revise PSA testing may come from different quarters: umbrella associations that look objectively at the research and decide to change their guidelines, ROs at the hospital, who may already be pushing for (very) early SRT which requires uPSA, and, perhaps individual uros there who, for whatever reason, want the added info/lead time afforded by uPSA. At our last chat about post-op PSA levels above/below which might prognosticate for BCR liklihood, such as 0.01 and 0.03, my uro concluded with "uPSAs are still controversial."

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, 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 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

  5. #15
    Quote Originally Posted by IndyGuy View Post
    Michael,

    My gut feeling is most doctors are looking for PSA trends regardless as to whether you are getting tested at the 0.0, 0.00 or 0.000 levels. I doubt anyone is going to make a treatment decision based on what's happening in the third decimal place. So, to your point, why not just use 0.00 testing? In my case, I'm definitely more interested in whether my PSA will trend from 0.01 to 0.03 than from 0.010 to 0.015. Brothers at higher PSA levels, say 0.1 and above certainly have zero interest regards what's happening in the third decimal place.

    I'm not saying I'm not going to fret some if my uPSA go up slightly - I will - but only for the following 3 months.

    Also, I had my prostatectomy done at Indiana University Health - which is a research hospital. They routinely use uPSA testing. I'm not sure why other - more prestigious - research institutions like Mayo or JH don't use it routinely.
    Hi IG! Re:

    Exactly! I fully agree ">" 100%!!! (This is my point in Post #2.)

    Do you know where your uPSA is analyzed and by what Methodology? Or to ask differently: "Do you get & retain copies of The Original Lab Report each time?!?!?"

    My "hunch" is: at 6 months post RP, you will be inducted into the elite "< 0.01 Club!!!"

    MF

  6. #16

    Did Dj Just Answer OTS' Question?

    See Honeybun078's Thread Titled: "Psa Frequency" / Post # 13 / 1st Abstract / Results Section, 2nd sentence:

    https://www.cancerforums.net/threads...requency/page2


    "undetectable prostate specific antigen levels (less than 0.01 ng/ml)"


    IMO following RP:

    - There remains no universally accepted cutoff point for Detectable vs Undetectable

    - If using a Standard PSA Methodology, any value < 0.1 ng/ml => Undetectable

    - If using an ultrasensitive PSA Methodology, any value < 0.0? ng/ml => Undetectable Feel free to fill in ?!!!

    - PSA Dynamics / Kinetics / Rate of & Direction of Change is/are the key(s) to identifying pending BCR

    - FB Another (Post #4) has provided us with the best and most concise definition of Detectable: "Anything with a < sign in front of it."

    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 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

  7. #17
    Experienced User
    Join Date
    May 2019
    Posts
    63
    Quote Originally Posted by Michael F View Post
    Do you know where your uPSA is analyzed and by what Methodology? Or to ask differently: "Do you get & retain copies of The Original Lab Report each time?!?!?"
    I don't get copies of my lab results but I do go to the same place at the hospital for a blood draw each time. I assume they are using the same lab each time.
    DOB: 10/1962

    6-01-15 PSA 2.5
    Having urination flow issue in first half of 2018. Flomax 6/1-6/21 - no help.
    6/25/18 PSA 14.25; Cipro 14 days
    8/1/18 PSA 17.44; rec. Urologist appt
    8/15/19 First Uro appt. + for bacteria. Cipro 4 weeks
    10/2/19 PSA 22.4; Still + for bacteria. Antibiotics 4 more weeks
    12/28/19 PSA 27.5
    1/15/20 Biopsy results 6/12 cores positive - all left side; GS 4+3
    1/18/19 Bone scan and CT scan both negative
    2/15/19 Di Vinci RP
    2/18/19 Path report pT3a, GS 4+3 (60%+35%) 5% GS5, SM +, EPE +; LVI -, SVI -, LNI(9) - ; Tumor size: 3.5cmx3.5cmx1.5cm (yikes); single foci left side; right side nerves spared; SM+ at apex limited <1mm; benign prostatic cells noted at spared right nerve bundle margin. Prostate size 45gm.
    Cath out at 7 days: 100% continent with some ED; ok with 10mg Cialis.
    Decipher 0.73 - 5-year Metastasis risk 19%; 10-year PCSM 13%.

    PostOp PSA testing:
    3/26/19 (6 weeks) 0.033
    5/10/19 (3 months) 0.010
    8/02/19 (6 months) 0.019

  8. #18
    Senior User
    Join Date
    Jan 2019
    Posts
    479
    Quote Originally Posted by DjinTonic View Post
    I agree with your definition, but it could matter. The NCNN Guidelines uses the word undetectable 31 times. It would help to know exactly what they mean While low-risk men can sit comfortably with a post-op undetectable of <0.1, some high-risk men who just managed to skirt adjuvant RT after their path report came out might not be as comfortable with that level of (un)detection.

    What has seemed to hold steady is the PSA level used for the "official" definition BCR, 0.2, with a confirmed, rising trend.
    The NCNN will not define undetectable because it would require hospital labs to be in compliance with their standard. Which would start a shit storm.
    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.

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

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

  9. #19
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    Aug 2016
    Posts
    1,653
    Undetectable is a choice in test limit and is dependent on your treatment plan. There is no controversy in it. Your treatment plan and the sensitivity of the test to monitor for it is between you and your doctor.

    Guidelines for detecting PSA for additional treatment, if there are any, are dependent on your treatment plan.

    This is different than guidelines for screening for the disease which is controversial because of the multitude of factors; age, ethnicity, family history, life expectancy, and treatment options, and the unpredictability of prostate cancer on one's life quality and expectancy, imo. Should it be 3.0 or 4.0?

    Less than 20% of eligible men are screened annually for prostate cancer. Why isn't that a controversy?
    Last edited by Another; 07-21-2019 at 04:02 PM.

 

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