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Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?

Posted by Tom @tom86, Aug 7 10:53am

I have been fortunate enough to experience PSA results of <.01 post prostatectomy. Now, at the 6 year mark, I have had a result of .02. I realize this is not a huge amount, however, wondering if anyone else has had this experience and what to expect going forward. I was very high risk at T3b, SVI, ECE, PSA 11, PNI, 4 +3. Wondering if I should expect a rapid increase now that it has reared it's ugly head? I have been very blessed so far. I would appreciate hearing from anyone else who has had similar experience. Thank you. Tom

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notpetecrowarmstrong | @notpetecrowarmstrong | Sep 15 9:36am
In reply to @soli "@esperling I understand your concerns and wish you the best possible outcome. We do have similar..." + (show)
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@esperling
I understand your concerns and wish you the best possible outcome. We do have similar high-risk biology and pathology, except that my surgical margins were negative.

My surgeon does not track PSA at the ultrasensitive level like yours does, so at the one-year mark after surgery, my fourth consecutive PSA test was reported as “undetectable,” meaning <0.02. It’s possible that an ultrasensitive test might have detected a low but measurable PSA and provided information about its trend or doubling time, but I have no way of knowing because of the type of PSA testing I’ve been having.

That is one of the reasons I plan to consult with a radiation oncologist very soon—to discuss whether ultrasensitive PSA testing would be more appropriate for my situation and how best to monitor for a potential recurrence.

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@soli A test that measures down to 0.02 is already an ultrasensitive test. What leads you to think it isn't?

It's true that some uPSA tests can go a bit lower than that, to 0.01 or even 0.006 in the case of LabCorp. But different tests have different methodologies, two of the most common being Roche ECLIA and Beckman Coulter. These can be a little bit like Farenheit and Celsius scales in that a conversion is required: 0.02 on one is not equal to a 0.02 on the other. So depending on the methodology of your test, you may already be effectively testing down to the same levels as other men who report <0.01 socres.

A standard PSA test typically only measures down to 0.1. Your test can already detect 5x lower than that and you're unequivocally well into the ultrasensitive range. I wouldn't do anything differently in your shoes.

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soli | @soli | Sep 15 10:51am

Thanks for the detailed explanation. That’s very helpful, and I think you’ve clarified something that can easily be misunderstood.

My concern was not really about whether a test that can measure down to 0.02 qualifies as an ultrasensitive PSA test—it clearly does. My concern was whether my particular assay reports PSA values below 0.02, such as 0.01 or 0.006, or simply reports anything below 0.02 as “undetectable.” In the latter case, potentially useful early information about a rising PSA trend could be masked.

I’ll try to check with my lab to find out exactly which PSA assay/methodology they use and what its lower reporting limit is. That should give me a better understanding of what my “<0.02” results actually tell me.

Thanks again for pointing this out. I appreciate the clarification.

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notpetecrowarmstrong | @notpetecrowarmstrong | Sep 15 11:01am
In reply to @soli "Thanks for the detailed explanation. That’s very helpful, and I think you’ve clarified something that can..." + (show)
Profile picture for soli @soli

Thanks for the detailed explanation. That’s very helpful, and I think you’ve clarified something that can easily be misunderstood.

My concern was not really about whether a test that can measure down to 0.02 qualifies as an ultrasensitive PSA test—it clearly does. My concern was whether my particular assay reports PSA values below 0.02, such as 0.01 or 0.006, or simply reports anything below 0.02 as “undetectable.” In the latter case, potentially useful early information about a rising PSA trend could be masked.

I’ll try to check with my lab to find out exactly which PSA assay/methodology they use and what its lower reporting limit is. That should give me a better understanding of what my “<0.02” results actually tell me.

Thanks again for pointing this out. I appreciate the clarification.

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@soli No problem, happy to help clarify.

And if your result is coming back as "<0.02" then that means 0.02 is the lowest your test will detect, and you are undetectable by definition.

It's only if you weren't seeing the less-than sign that it would be the case your test could detect lower.

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