New type of test for PSA: Prostate Screening EpiSwitch (PSE) test

@joem, bens1 was discussing the PSE just last week https://connect.mayoclinic.org/discussion/pse-test-for-prostate-cancer-before-an-mri-and-for-re-occurrence/

Joe , In Canada we are starting to experiment with a "spit test type PSA test " . Is this the one yoru talking about . Its quite accurate I hear and no needle ! Have you heard of this one ? James

No, PSE is a newish proprietary approach that combines a regular PSA test with an epigenetic test to show if certain cancer-related markers show up in the bloodstream. The idea is that the epigenetic test refines the PSA test and reduces false positives for screening in the general population.

For those of us who've already been biopsied and know we have cancer, I'm not sure the epigenetic part adds any value (as @jeffmarc has pointed out, the genetic markers *should* be there anyway), but it's early days, and I'm still reading and learning.

In the meantime, once one has had radiation therapy or a prostatectomy, the PSA test alone — especially the ultrasensitive one that many of us get — increases its value for detecting possible recurrence. Normally, most PSA comes from the prostate, so an elevated PSA when the prostate has been removed or radiated indicates that something else (i.e. cancer) is likely producing it.

The literature reports a few cases of prostate cancer progressing while PSA is still low-ish (e.g. < 2.0), but personally I haven't yet read of progression when PSA is < 0.01 on the ultrasensitive test.

Actually @northoftheborder The literature reports a few cases of prostate cancer progressing while PSA is still low-ish (e.g. < 2.0),

I’ve seen a couple of articles that have warned there can be progression even though the PSA is very low.

Here is one of them from the arches study
https://dailynews.ascopubs.org/do/arches-analysis-underscores-importance-regular-imaging-detect-progression-patients
This really worries me since a PSMA pet test isn’t gonna work well if you’re PSA is < .1. But there can be radiographic progression which can be seen in the CT scans and bone scans. That’s why I get those scans yearly even though my PSA is undetectable.

They’re also the 10% of people that don’t produce PSMA so the PSMA Pet test doesn’t work for them. And then there’s those with neuroendocrine prostate cancer that can’t be seen by the PSMA pet test either. PSA can be undetectable for these groups, but progression is occurring.

I think we wrote the same thing. 🙂

Me: "The literature reports a few cases of prostate cancer progressing while PSA is still low-ish (e.g. < 2.0), but personally I haven't yet read of progression when PSA is < 0.01 on the ultrasensitive test."

You: "Actually @northoftheborder The literature reports a few cases of prostate cancer progressing while PSA is still low-ish (e.g. < 2.0), "

Have you read of any cases of progression with PSA < 0.01? I haven't yet, but I'm keeping my eyes open.

The article you linked is interested: it mentions that the -lutamides can suppress PSA even in cases when cancer might be progressing, but it mentions only "quite low" and "nadir" vaguely, not fully undetectable PSA specifically. It would be interesting to know if any of those cases involved undetectable on the uPSA test.

Another study did talk about the fact that with your PSA undetectable it can grow. I didn’t save that article unfortunately. That arches study did have people with very low PSAs.

Yeah, I do wonder if with a < .01 if it can still occur.