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Old 07-27-2010, 10:11 AM   #1
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Red Nighthawk HB User
Should I be nervous?

Should I be nervous? My recent PSA came back .05. The previous three, since surgery, have been:

.04 at four weeks post op
.03 at three months
.02 at six months

.05 at nine months

I realize it's still low, but should I be concerned that it went up at all?

thank,

john

 
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Old 07-27-2010, 11:14 AM   #2
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Johnt1 HB UserJohnt1 HB UserJohnt1 HB UserJohnt1 HB UserJohnt1 HB UserJohnt1 HB User
Re: Should I be nervous?

According to Dr Strum, a well respected Prostate Oncologist, a serial increase in the ultra sensitive psa test will identify a reoccurrance up to three years earlier than waiting for it to hit the recognized threshold of 0.2. You can go on prostate pointers P2P and post your question and stats and Dr Strum will answer you.
JohnT

 
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Old 07-27-2010, 01:30 PM   #3
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Re: Should I be nervous?

Quote:
Originally Posted by Red Nighthawk View Post
I realize it's still low, but should I be concerned that it went up at all?


Hi John M,

My short answer is, “Probably not.”

Would I be a little worried? Probably, but that’s what “PSA anxiety” is all about…which was a choice you and/or your doctor made when the selection of the ultrasensitive PSA test was made instead of the standard PSA test.

I recall from your case that your post-operative Gleason score was 3+4, cancer in less than 5% of your prostate, no lymphatic/vascular invasion, no seminal vesicle or extraprostatic involvement, and negative surgical margins. Your calculated likelihood of being cancer free was 93%.

So, your question is whether you are actually in the 7% group, rather than the 93% group…right?

Probably not.

Remember, I posted to you last winter that ultrasensitive test result variation (up or down) in the hundredths-place is not uncommon…

Johnt1’s comment is true. Re-stating it in my own words: For someone who had an initially low (undetectable by standard PSA test; below 0.1 ng/mL) result which eventually rose to BCR, they could have probably watched it rise over time by plotting ultrasensitive results over time.

AND, there are some studies which show that early initiation of salvage RT after post-operative BCR leads to better outcomes. HOWEVER, there are also risks of over-treatment if unnecessary salvage therapies are administered to the false-positive patients

I would say that the most sage information for your situation is was given by Daniel W Chan, Ph.D., professor of pathology, oncology, urology and radiology, and Director of Clinical Chemistry at Johns Hopkins.
''You cannot reliably detect such a small amount as 0.01,'' he explains. ''From day to day, the results could vary -- it could be 0.03, or maybe even 0.05'' -- and these ''analytical'' variations may not mean a thing.

''It's important that we don't assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it's less than 0.1, we assume it's the same as nondetectable, or zero.''
Wait for your 1-year result. Keep exercising, eating healthy, reducing stress, and enjoying life.

Last edited by kcon; 07-27-2010 at 01:32 PM. Reason: added bold to one sentence

 
Old 07-27-2010, 03:54 PM   #4
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Re: Should I be nervous?

Quote:
Originally Posted by kcon View Post
Hi John M,
Kcon, your note is most reassuring and I thank you for your knowledge and willingness to share. I'm not really worried--yet!

Thanks again and be well.

john

My short answer is, “Probably not.”

Would I be a little worried? Probably, but that’s what “PSA anxiety” is all about…which was a choice you and/or your doctor made when the selection of the ultrasensitive PSA test was made instead of the standard PSA test.

I recall from your case that your post-operative Gleason score was 3+4, cancer in less than 5% of your prostate, no lymphatic/vascular invasion, no seminal vesicle or extraprostatic involvement, and negative surgical margins. Your calculated likelihood of being cancer free was 93%.

So, your question is whether you are actually in the 7% group, rather than the 93% group…right?

Probably not.

Remember, I posted to you last winter that ultrasensitive test result variation (up or down) in the hundredths-place is not uncommon…

Johnt1’s comment is true. Re-stating it in my own words: For someone who had an initially low (undetectable by standard PSA test; below 0.1 ng/mL) result which eventually rose to BCR, they could have probably watched it rise over time by plotting ultrasensitive results over time.

AND, there are some studies which show that early initiation of salvage RT after post-operative BCR leads to better outcomes. HOWEVER, there are also risks of over-treatment if unnecessary salvage therapies are administered to the false-positive patients

I would say that the most sage information for your situation is was given by Daniel W Chan, Ph.D., professor of pathology, oncology, urology and radiology, and Director of Clinical Chemistry at Johns Hopkins.
''You cannot reliably detect such a small amount as 0.01,'' he explains. ''From day to day, the results could vary -- it could be 0.03, or maybe even 0.05'' -- and these ''analytical'' variations may not mean a thing.

''It's important that we don't assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it's less than 0.1, we assume it's the same as nondetectable, or zero.''
Wait for your 1-year result. Keep exercising, eating healthy, reducing stress, and enjoying life.

 
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