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  • First uPSA

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    Old 01-22-2020, 12:31 PM   #1
    IceStationZebra
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    First uPSA

    Today I received some pretty good news.

    My path report showed perineural invasion and a tiny 3 mm positive margin in the right lateral base. So I didn't have great faith that we got it all on 12/9.

    Well my uPSA came back at <.1 today a little over a month since surgery. So hopefully that trend continues! I'm definitely relieved.

     
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    Old 01-22-2020, 06:21 PM   #2
    Insanus
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    Re: First uPSA

    Quote:
    Originally Posted by IceStationZebra View Post
    Today I received some pretty good news.

    My path report showed perineural invasion and a tiny 3 mm positive margin in the right lateral base. So I didn't have great faith that we got it all on 12/9.

    Well my uPSA came back at <.1 today a little over a month since surgery. So hopefully that trend continues! I'm definitely relieved.
    Get at least a 2 decimal test. <.1 doesn’t mean much.

     
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    Old 01-22-2020, 06:28 PM   #3
    IceStationZebra
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    Re: First uPSA

    Quote:
    Originally Posted by Insanus View Post
    Get at least a 2 decimal test. <.1 doesn’t mean much.
    It is what the doctor uses, I don't have a choice.

     
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    Old 01-22-2020, 07:42 PM   #4
    DjinTonic
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    Re: First uPSA

    I wouldn't worry about PNI being seen in RP tissue. Estimates of this finding go up to >80% of RP exams. (PNI+ found at biopsy is thought to prognosticate adverse findings at RP, but you have passed that point and have your path findings).

    As to removing all PCa with the RP, the proof will be in the pudding: after a RP, PSA becomes a highly specific indicator of surviving and growing benign and malignant prostate cells.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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    Old 01-22-2020, 07:50 PM   #5
    IceStationZebra
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    Re: First uPSA

    Quote:
    Originally Posted by DjinTonic View Post
    I wouldn't worry about PNI being seen in RP tissue. Estimates of this finding go up to >80% of RP exams. (PNI+ found at biopsy is thought to prognosticate adverse findings at RP, but you have passed that point and have your path findings).

    As to removing all PCa with the RP, the proof will be in the pudding: after a RP, PSA becomes a highly specific indicator of surviving and growing benign and malignant prostate cells.

    Djin
    Is <.1 specific enough in your opinion?

    It kind of bugs me that my surgeon only uses the single decimal but is it enough to warrant switching docs ?

     
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    Old 01-22-2020, 09:01 PM   #6
    Insanus
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    Re: First uPSA

    Quote:
    Originally Posted by IceStationZebra View Post
    It is what the doctor uses, I don't have a choice.
    Sure you do. Where your lab tests are done is your choice. Have your doc send an order to the lab you want.

     
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    Old 01-23-2020, 08:24 AM   #7
    Prostatefree
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    Re: First uPSA

    <0.1 testing is specific enough if everything went/goes right.

    The only adverse aspect to your profile is your young age, imo. Everything else implies no further issues, and prudence implies always monitor it. So, if you are going to monitor it, then monitor it with something that has the most use to you.

    I'd use a two decimal test for all post RP testing.

    Your doctor will do it if you request it. Your young age is your trump card.

    By most protocols, your test is fine.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 01-23-2020, 08:30 AM   #8
    IceStationZebra
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    Re: First uPSA

    Quote:
    Originally Posted by Prostatefree View Post
    <0.1 testing is specific enough if everything went/goes right.

    The only adverse aspect to your profile is your young age, imo. Everything else implies no further issues, and prudence implies always monitor it. So, if you are going to monitor it, then monitor it with something that has the most use to you.

    I'd use a two decimal test for all post RP testing.

    Your doctor will do it if you request it. Your young age is your trump card.

    By most protocols, your test is fine.
    I actually just sent a portal message in to my PCP--they're great--to see if they could order the super sensitive upsa test with the tracking analysis (labcorp). My insurance requires labcorp so provided my PCP is willing I will just have the test done there and take it with me to my urology office. I don't want to argue with the expert but I'm an Accountant and decimals matter.

    So we will see.

     
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    Old 01-23-2020, 08:50 AM   #9
    DjinTonic
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    Re: First uPSA

    Quote:
    Originally Posted by IceStationZebra View Post
    I actually just sent a portal message in to my PCP--they're great--to see if they could order the super sensitive upsa test with the tracking analysis (labcorp). My insurance requires labcorp so provided my PCP is willing I will just have the test done there and take it with me to my urology office. I don't want to argue with the expert but I'm an Accountant and decimals matter.

    So we will see.
    The 3-decimal Labcorp uPSA is perhaps the most sensitive test with widespread availability in the U.S. IMO it makes no difference whether you get the test with or without "serial monitoring." The uPSA test itself is identical. The monitoring gives you a separate document graphing your values over time. The (rather comical) problem with this graph is that the Y-axis goes from 0 to 20.000, so unless your PSA really takes off, values <0.100 will essentially merge with the X-axis

    I emailed Labcorp that the graph would be much more meaningful if the max. value on the graph was proportional to your max PSA value or at least a smaller fixed value --no reply.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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    Old 01-23-2020, 09:13 AM   #10
    IceStationZebra
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    Re: First uPSA

    Quote:
    Originally Posted by DjinTonic View Post
    The 3-decimal Labcorp uPSA is perhaps the most sensitive test with widespread availability in the U.S. IMO it makes no difference whether you get the test with or without "serial monitoring." The uPSA test itself is identical. The monitoring gives you a separate document graphing your values over time. The (rather comical) problem with this graph is that the Y-axis goes from 0 to 20.000, so unless your PSA really takes off, values <0.100 will essentially merge with the X-axis

    I emailed Labcorp that the graph would be much more meaningful if the max. value on the graph was proportional to your max PSA value or at least a smaller fixed value --no reply.

    Djin
    That's funny....a useless graph

     
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    Old 01-23-2020, 09:23 AM   #11
    DjinTonic
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    Re: First uPSA

    Quote:
    Originally Posted by IceStationZebra View Post
    That's funny....a useless graph
    Actually, you could say it's graphical evidence that your very low values are "essentially zero." In any case, I predict your values will be etched in you mind, as mine are.

    Djin

     
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    Old 01-23-2020, 09:30 AM   #12
    IceStationZebra
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    Re: First uPSA

    Quote:
    Originally Posted by DjinTonic View Post
    Actually, you could say it's graphical evidence that you very low values are "essentially" zero. In any case, I predict your values will be etched in you mind, as mine are.

    Djin
    No doubt. I heard back from my. PCP and they said no they don't do the ultra sensitive PSA. So I'm stuck with either the single digit or in have to doctor shop to find one who will do the ultra sensitive PSA.

    I don't see that my surgeon, who was chosen because of his expertise in the procedure, has any significant reason for being right? If my PSA goes up he cannot operate again and I would be referred to a radiation oncologist.... so maybe it's time to find a new doc closer to home. Current doc is an hour away each way.

    I'm also debating the testosterone (once we have proof of the consistent PSA). The doc is definitely for it but Another from the other board has me freaked out I'll be killing myself if I do 😁

     
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    Old 01-23-2020, 09:35 AM   #13
    Prostatefree
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    Re: First uPSA

    I'd be cautious. Given your young age you can wait 5 years before attempting it, imo. Don't intend to freak you out.

    What may be helpful is studies on recurrence for similar profiles to yours (young with G6) with or without testosterone.

    Your doctor had you on it before, so he's all in on your dime (cancer risk).

    Another
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 01-23-2020, 09:39 AM   #14
    Prostatefree
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    Re: First uPSA

    Quote:
    Originally Posted by IceStationZebra View Post
    No doubt. I heard back from my. PCP and they said no they don't do the ultra sensitive PSA. So I'm stuck with either the single digit or in have to doctor shop to find one who will do the ultra sensitive PSA.

    I don't see that my surgeon, who was chosen because of his expertise in the procedure, has any significant reason for being right? If my PSA goes up he cannot operate again and I would be referred to a radiation oncologist.... so maybe it's time to find a new doc closer to home. Current doc is an hour away each way.

    I'm also debating the testosterone (once we have proof of the consistent PSA). The doc is definitely for it but Another from the other board has me freaked out I'll be killing myself if I do 😁
    He doesn't have to shop. Each major national lab has it even if he doesn't have it in his; Quest or LabCorp. Tell him to send it over to the one most convenient for you. I have a Quest 3 blocks from my house. Very convenient.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 01-23-2020, 09:44 AM   #15
    DjinTonic
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    Re: First uPSA

    Quote:
    Originally Posted by IceStationZebra View Post
    No doubt. I heard back from my. PCP and they said no they don't do the ultra sensitive PSA. So I'm stuck with either the single digit or in have to doctor shop to find one who will do the ultra sensitive PSA.

    I don't see that my surgeon, who was chosen because of his expertise in the procedure, has any significant reason for being right? If my PSA goes up he cannot operate again and I would be referred to a radiation oncologist.... so maybe it's time to find a new doc closer to home. Current doc is an hour away each way.

    I'm also debating the testosterone (once we have proof of the consistent PSA). The doc is definitely for it but Another from the other board has me freaked out I'll be killing myself if I do 😁
    If an RP happens to leave some PCa behind, surgery isn't done or practical. The malignant tissue can be tiny or micrscopic and may be in essential structures, like the bladder neck. Nor can it be easily identified visibly or tactically. An exception is an extended pelvic lymph node dissection, to remove a large number regional lymph nodes if lymph node invasion is found after the RP.

    If you can't find a doc to order it so you get insurance coverage, you can order and pay out of pocket for the Labcorp (3 decimal, $109) or Quest (2 decimal) test :

    https://www.walkinlab.com/men-s-wellness-tests/prostate.html

    Djin

     
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