PSA undetectable!

@jc76 - nothing too interesting, I studied psychometrics in graduate school.

I asked about a post-op Decipher @jeffmarc and several times about ultra-sensitive PSA tests @brianjarvis and my surgeon at the Cleveland Clinic doesn't think either are necessary. I'm not too sure what the updated Decipher would add since I'm already considered high risk (no BRCA1/2 mutations). I also asked about a referral to a GU/MO but was told that happens if/when PSA > 0.2.

For now, I'll get my PSA tested every three months. If it becomes detectable, I will up my squeaky wheel level considerably.

@psychometric Same at Mayo. So that's two top-notch that don't do it.

@dhasper I did consider getting an ultrasensitive done myself but what is the point? They are not going to act on anything below .1 or even .2 anyway. .1 will give you plenty of time to get treatment plans in place. I guess you could get an estimate of doubling time but that isn't going to change the treatment plan either.

I can see and understand everybody's view point (both doctor's and member's here). However, once you get blindsided (actually twice in our case) by false sense of "correct protocol", one gets super vigilant. We were advised to do ultra sensitive by our surgeon and also RO and my husband will always do ultra sensitive test anyways since doubling time has it's "prediction" quality - if it is really fast than a more aggressive salvage should be implemented (maybe longer ADT, or maybe triplet instead of doublet therapy, etc). IMHO having extra data is never bad idea, and catching cancer super early is always important. Salvage can be done earlier that 0.2 BTW. If there is clear rise and fast doubling waiting to 0.2 can cause PSA to rise ABOVE 0.2 while waiting for marker placement and scheduling etc. and one does not wish to go above 0.2 if at all possible.
Yes, having ultra sensitive test is more nerve wracking but what is not nerve wracking about having PC *sigh ?

CONGRATS !!! : ))) And may it stay that way forever !!! 🍀✨

@psychometric
I had RARP in April at Cleveland Clinic and was likewise told that there was no need for a post-op Decipher or an ultra-sensitive PSA. Fortunately both of my PSAs have been "< .02" which I understand to be undetectable.

Great news! I too am a pT3b with Cribriform glands, but "with" surgical margins. You are lucky! Question though: You write:
"Intraductal Histology: No."
But...further down, you write:
"Intraductal carcinoma: Atypical intraductal proliferation, suspicious."
I am curious about that...did your urologist explain the disparity or contradiction?
Glad to hear of your good news!

@rlpostrp

My husband had 2 opinions about biopsy slides - one said IDC, the other IDC suspected. After RP it was confirmed - there was IDC present. When they say "suspicious", that means that it can be"it", but that they are not sure if it really is "it", or just looks like "it".

You unfortunately had what in my opinion was a poor pathologist read the slides. I was the Director of Clinical and Anatomical Laboratory Services in a couple of hospitals for the first 20 years of my 40-year Laboratory career. As a pathologist you make the definitive call, and you say what it is or isn't. You don't leave a physician or his/her patient "hanging" with a non-descript comment like "suspicious." In this case, you grab some other slides from the same area of the specimen and look at them again, and come to a definitive conclusion. It is also common practice to have at least one other, if not two other pathologists review the same slides for diagnostic concurrence. If there is a difference of opinion, the pathologists briefly discuss it and come to a definitive conclusion to comment on the pathology report. You don't write"suspicious", or "concerning", or "suggestive", or another such word that is not definitive. I am sorry that you experienced that.

Ah, yes, USPSA vs the traditional single decimal point < .1

Over the years, I've not seen consensus on which one.

In part, I think it may be a function of how you and your medical team approach treatment decisions.

The age-old question, "just because we can, should we?"

My perspective, depends on what you want to do with the data.

I've used this analogy before, those who are familiar with driving in eastern Colorado (I live in Kansas City, we often vacation in Colorado) know that you can see the distant headlight of a train miles and miles away. So, you know it's coming, question is what to do with that data. I mean, going back to high school algebra, you could unscientifically estimate the time of arrival where your paths cross and you have a decision to make.

For my medical team and I, given my clinical history, we use the USPSA because of our decision-making criteria about treatment:

Three or more consecutive PSA increases spaced three months apart which show a continuous increase.
AND
PSA between .5-1.0

Why those? We want a trend, not aberration in the PSA and statistically, we have a 2/3 probability of a PSMA scan locating the recurrence, thus informing the treatment decision.

If you think back to the "old days," imaging such as the CT/MRI was not very sensitive, certainly at below .1 it wasn't going to show anything. Heck, in 2016 Mayo wouldn't see me until my PSA was above 2 given the sensitivity of their C11 Choline scan.

Each of us faces a personal decision, what constitutes actionable clinical data to initiate treatment? I have seen some literature that says actionable metastatic disease can take 8-10 years before impacting one's life. That argues for the traditional PSA testing. Then again, some literature says that MDT by itself can push back the need for systemic therapy, that may argue for USPSA...

On the other hand, those with high-risk features, GS, GG, PSADT, PSAV, pathology report, time to BCR, genetic testing results, Decipher...may want to treat earlier. I'm in that group.

There are other variables, someone who is in their 50 or 60s versus 80s may approach decision making differently with respect to the clinical data...

So, as always, think about what you want, discuss with your medical team.

Kevin