PSE Test for Prostate Cancer Before an MRI and for Re-Occurrence

It is done. I didn’t look closely after I wrote it.

Six months post HoLEP prostatectomy my PSA was at 0.911
The urologist surgeon said "you're cured." Come back in six months for another PSA." I asked why would I need to have another test if I'm "cured?" He said it's standard. I asked why and he said it was to make sure there was no cancer. I commented that the "cured" statement is moot. When he told me my PSA was .911, I mentioned that it should be < 0.2
He said that I still have the capsule, that it could be any number, that perhaps I have "another cancer." But, other cancers don't produce PSA, it's a marker intrinsically made by the prostate.

@northoftheborder Steven Arrivo basically said that even after treatment, if one is looking for biological re-occurrence, the test will pick up the changes regarding new or changed cancer cells. Again, he made it clear to me that if anybody had any questions, to email him.

How often one takes the test is a good question.

Very interesting. Their announcement last year cited accuracy figures only for initial screening, not for surveillance:
https://www.news-medical.net/news/20230208/New-blood-test-can-detect-prostate-cancer-with-greater-accuracy-than-current-methods.aspx
Perhaps they're in the process of collecting new data to determine whether PSE produces better outcomes for surveillance as well.

I completed salvage radiation last May. I have been on ADT for 11 months (6 months of Eligard followed by 5 months of Orgovyx + Abiraterone. My original episode was in September of 21 when my PSA was 23. I had RP - pathology was GS 4+4 stage Pt3b. I had persistent PSA, 60 days post RP PSA was 7. Did about 2 years of intermittent Bicalutamide. Went to Houston for RO consult. They put me on the Eligard and performed the SR. Last PSA was < 0.01. My MO thinks i have a good chance for cure but wants me on ADT another 7 months for micro metastases . I wonder if a test like this could tell if there are any micro metastases or if it’s safe to stop ADT?

@northoftheborder here is what Steve Arrivo just emailed me: “ PSE is a perfect test to show prostate treatment(s) were effective: focal ablation, prostatectomy, proton therapy, etc. as the cancer should be removed and therefore none detected. We have seen men with prostatectomies as far as 10 years out with a rising PSA and they have shown a high likelihood of cancer being present (which as we discussed is greater than 90% accurate – positive predictive value = 93%).”

I'm not a medical professional, so someone who knows more please feel free to step in, but for detecting small metastases I think the best available test is still a PSMA PET scan.

I haven't see anything in my layperson reading on PSE so far to suggest that it is related to detecting specific metastases; instead, it combines epigenetic testing with PSA testing to get a better idea of the probability of cancer and cancer progression — in general terms — than either test can give alone. Think of it as adding some more certainty to deciding whether it's time to act on rising PSA yet.

Thanks -- that's helpful.

Did he say what the additional predictive value was over rising PSA alone after a radical prostatectomy or major radiation?

I can see the value of a testing refinement after highly-focussed treatment like proton therapy or a focal ablation, when enough of the prostate still functions that rising PSA could be harmless, but if they've completely removed the prostate or fried it thoroughly a high dose of photon-based EBRT, then I'd think any rising PSA is automatically cause for concern (since we know it's not coming from the prostate), and the main value of adding epigenetic testing would be to confirm that epigenetic testing works.

What is SR?

@northoftheborder "additional predictive value ": he did not discuss this.

In terms of when you take the test post treatment, I believe this test has not been out there long enough, at least in the US, to work out a monitoring plan that nccn or doctors in general are ready to put in place.