My first PSA test after surgery

@jeffmarc It looks to me that the assay that was being used only has a <0.08 sensitivity.
@mpersonne You may want to look at ultrasensitive assays moving forward. I do with <0.02 sensitivity. There are even tests with higher sensitivity, but they have a risk of falsely detecting small positive amounts of PSA and thus creating unnecessary anxiety.

I agree with Jeff's note of caution. I also suggest you take a look at the thread "Is PSA 0.032 after radical prostatectomy a normal fluctuation?After ra?" elsewhere in today's email listing all the discussion threads. Later today, I will put more detail in that thread but the short version is if your pathology shows you have aggressive cancer (e.g., high Gleason or
Decipher score, presence of cribriform, PNI, IDC, EPE, seminal vesicle invasion, not all clean margins during surgery), then I would definitely get the ultra-sensitive test. If you are in that category, you have to be extra-vigilant about even small rises in your PSA.

@topf
While it may be true that they were limited in what they can show in a PSA test I’ve never heard of a two digit PSA not being ultra sensitive. They don’t need to put a zero after the eight.

Normal PSA tests that are not ultrasensitive only have one digit, when you have two digits It’s a lab That does ultra sensitive.

@rhilbert0
It freaked us "for a reason" and we are happy that we did uPSA since we caught BCR on time and my husband started treatment before he hit 0.2 - early salvage gives much better results than salvage above 0.2.

I would strongly advise everybody to have uPSA and especially if your Gleason was anything above 3+4 , or you had cribriform or IDC or high Decipher (for RT patients) and for RP all of the above plus if you had positive margin, EPE, ECE, or vesicle involvement.

@rhilbert0 wrote "At Mayo, anything less than .1 is called undetectable. You shouldn't get tests more sensitive than that"

This is poor advice as a blanket statement. There are many reasons why many men should be getting ultrasensitive PSA tests after RP. If you're happy with the standard test that reads down to 0.1, that's great for you. And I understand that Mayo has that as a default for resource optimization and public health reasons. But men with higher-risk pathology and higher risk for recurrence should talk with their doctors and strongly consider uPSA that reads down to 0.02 at minimum, to have earlier visibility into a rising PSA trend.

@surftohealth88
This is not the first (or second, or third) time Surf and I have been singing from the same song book:)

@jeffmarc I agree it’s confusing. Should be either « <0.08 » or « 0.080 ». I agree that if it is an actual 0.08 reading that it requires close monitoring.

@rhilbert0 Sure? I am glad to hear that. I trust Mayo Clinic. At MSK anything above 0.05 is signal of cancer presence. I have been on stage 4 since June 2019. I was given 3 or 4 years of survival, this is the 7th. Since I didn't die, on August 2023 I asked my oncologist to stop all medications until my PSA rises above 1. He agreed. For 3 years it had been around 0.30. My last blood work had my PSA risen to 0.68. I am scheduled to a PET scan by mid August.
I welcome your message because at 80, I don't want to have anymore medication. I have also heard that low levels of PSA can come from many different sources.
Good luck.

@notpetecrowarmstrong
I don’t know what resource optimization is but I imagine public health reasons is so as not to instill unnecessary, uncertainty, stress and anxiety in patients as people with cancer are naturally going to have alot of those and don’t need more of it. You are right about the blanket statement you shouldn’t get tests more sensitive than under .1, just as the opposite blanket statement is also poor advice that all patients need to have ultra sensitive tests. Your premise is correct that their are many reasons to get one and I would imagine renown Mayo Physicians know when to make that call to order regarding those patients and the other reasons usually tied to aggressiveness or contributing factors making it aggressive.

@notpetecrowarmstrong
Just to add, I imagine that first post surgery PSA helps the physician’s make that call.