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Cancer: Prostate Message Board
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Old 04-19-2008, 06:39 PM   #1
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Don't understand PSA test sensitivity: is this good or bad?

Prostate removed with no extensions, margins, or visicule involvement: however 1 of 22 lymph nodes had "microscopic involvement": so I guess that trumps the previous good news? I noticed a lot of post RP PSA's here were .02, which I was hoping for but when it came back .1 I thought that seemed bad. I went to the nursing area and she referred me to the lab and she called someone and after a period of time I was told that .1 was the lowest sensitivity of the lab. The nurse and lab assistant said they just didn't know. I've looked at the PSA report and there is no mention of sensitivity, just PSA .1. Could .1 = 0 for this lab? My surgery hospital said .1 could be OK if the hospital sensitivity was .1: his hospital PSA sensitivity is .05. So, I guess a super sensitive PSA would certainly tell a much more thorough result? I guess I'm still not knowing where I "am".

 
Old 04-23-2008, 06:56 AM   #2
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Re: Don't understand PSA test sensitivity: is this good or bad?

Quote:
Originally Posted by richarda123 View Post
Prostate removed with no extensions, margins, or visicule involvement: however 1 of 22 lymph nodes had "microscopic involvement": so I guess that trumps the previous good news? I noticed a lot of post RP PSA's here were .02, which I was hoping for but when it came back .1 I thought that seemed bad. I went to the nursing area and she referred me to the lab and she called someone and after a period of time I was told that .1 was the lowest sensitivity of the lab. The nurse and lab assistant said they just didn't know. I've looked at the PSA report and there is no mention of sensitivity, just PSA .1. Could .1 = 0 for this lab? My surgery hospital said .1 could be OK if the hospital sensitivity was .1: his hospital PSA sensitivity is .05. So, I guess a super sensitive PSA would certainly tell a much more thorough result? I guess I'm still not knowing where I "am".
Hi Richard,

I know that lymph node result is not as good as you hoped, but it could have been a lot worse. I started a thread about node positive PC on 2/4/2008 at 12:17 PM that should have some helpful and encouraging information.

You could insist on being tested with an ultrasensitive PSA test with a sensitivity down to <0.01. That would give you a good idea of where you stand.

You asked: "Could .1 = 0 for this lab? My surgery hospital said .1 could be OK if the hospital sensitivity was .1: his hospital PSA sensitivity is .05." No; .1 as a lower limit simply means that the true result is somewhere between .1 and true zero, and that tells you very little about the possibility of recurrence. It does show that you haven't passed the generally accepted recurrence threshold of .2 immediately after surgery, which is of course a good thing. As for .1 being okay if the hospital's usual sensitivity limit is .1, no again. It simply means that the hospital has not recognized that modern PSA testing is now capable of providing far more information than a conventional PSA test will yield after surgery. To me it indicates the hopital is not very aware of modern prostate cancer therapy and monitoring; that's a strong sign to look elsewhere, though the hospital is probably fine for taking blood for testing.

Personally, I'm not fond of a .05 ultrasensitive limit either because research has now clarified what the odds of recurrence are for the values below .05 all the way down to <0.01, and the differences recurrence odds for the different values are substantial. But .05 is certainly far better than .1. I know that the Immulite Third Generation PSA test is capable of routine clinical readings with reliability down to <0.01. For me, my sample must be shipped frozen out of state, which adds extra days, but the detail is worth it.

It will probably take some work to arrange such an ultrasensitive test when you are working with people not used to using the test. It took me at least three false starts, as I recall it. At first, my oncologist ordered the test by name but did not specify the code, and the technician messed up. Later the code was specified too, but the sample wasn't sent properly by the technician. Another time the code was right but the technician, not used to handling ultrasensitive tests (and not speaking English well), overlooked the code and simply had a conventional PSA test run. After that, for a while I discussed the test details with each technician every time, and I talked with supervisors when a technician's English was shaky.

Did you have your PSA done locally or in Chicago? I'm guessing it was locally. You could call your surgeon's office in Chicago and get their advice.

I also hate to bring up an idea that you, as a resident in the heart of the dairy state, will probably find heretical, but it could help you beat prostate cancer. The idea is to implement a lifestyle approach to the disease. Unfortunately, that involves eliminating dairy food, including cheese, to the extent you can, and also cutting out red meat (including pork). I started a thread about that on 3/6/2008 at 1:39 PM, "Nutrition & lifestyle tactics."

It's possible that vitamin D3, pomegranate juice or extract tablets, and the other lifestyle tactics will be enough to counter any remaining prostate cancer, which you can track with ultrasensitive testing. However, research shows that follow-up radiation or hormonal therapy are better when started soon after surgery, with radiation started after the body has recovered from the surgery. My layman's thinking is that you are probably okay in delaying follow-up therapy as long as ultrasensitive testing indicates very low values that don't rise appreciably, but I say that just on my hunch and with no authority or even knowledge of research to back it up.

Also, some of the lifestyle tactics, particularly use of antioxidants like vitamin E and selenium, should be held in suspense during radiation. (That's because radiation works by creating free radicals that destroy the cancer cells, and antioxidants reduce free radical production.)

Take care and good luck,

Jim

 
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