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  • Up-Date From Big Al Latest Results uPSA

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    Old 05-14-2020, 04:11 PM   #1
    Bigalcalbisque
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    Up-Date From Big Al Latest Results uPSA

    As you can see from my signature that my uPSA has been fluctuating since 9-26-2019. My latest result was 0.03 which honestly kinda shocked me as I was not anticipating that at all having my last result at 0.06 about 3 months ago. Obviously it was a great feeling to see that but now I am left wondering what "is" going on here!! I will be consulting with my Radiologist as I still am a tad higher than <0.02 (undetectable)
    I was hoping that I could get some thoughts from the community.
    I am now 2 years 8 months past the Robotic Surgery.
    BTW: my Dr also had me do a Testosterone which was 427
    Not sure the significance of that????
    Thanks, Al
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

    Last edited by Bigalcalbisque; 05-14-2020 at 04:26 PM. Reason: Needed To Add Detail

     
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    Old 05-14-2020, 05:58 PM   #2
    IceStationZebra
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    Re: Up-Date From Big Al Latest Results uPSA

    I cannot be of significant help other than to say congrats and great news. Someone will be along shortly to help.

     
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    Bigalcalbisque (05-15-2020)
    Old 05-15-2020, 04:29 AM   #3
    Steve135
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    Re: Up-Date From Big Al Latest Results uPSA

    Let me be the first to say the PSA the numbers posted are that of a PSA test, 0.06 as apposed to a uPSA which could be something like 0.006
    uPSA is a three decimal place and a PSA test is two digit place.
    Several things could change your PSA levels such as attemps at sex and foods we eat? I have never had a rise and fall of PSA in nearly five years, thats not to say once it starts to move up it doesn't stop till doctors intervene.
    steve

    _________________
    Diag. 56 DOB 2/59 PSA Base 1.5 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins No tPresent inked margins 5 neg pT3a,N0
    PSA 10/16 <0.1 02/7/17 1st BCR 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm tumor rt. SVB Casodex + Trelstar
    04/17 SRT (42) to include location of tumor
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34
    7/19 0.06 8/19 0.08 9/19 0.05610/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion post SBRT 1/ 20 0.06 2/20 0.04 3/20 0.02 4/20 <.02

     
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    Old 05-15-2020, 05:27 AM   #4
    Michael F
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    Re: Up-Date From Big Al Latest Results uPSA

    Quote:
    Originally Posted by Bigalcalbisque View Post
    ...I was hoping that I could get some thoughts from the community....l
    Hi Baa! Take your latest uPSA as Good News! A PSA that is decreasing is always Good!

    The reality is: All of us who are post RP with elevated risks are on AS indefinitely!

    Thus we are only as good as our next uPSA value!!!

    You may become the Poster Boy for a bouncing 2nd decimal value! Using the general rule for pending BCR = 3 Consecutive uPSA Rises, you have reset and now start all over again at 0.03!

    Having an analytically measurable uPSA that is persistent but stable is good!

    MF
    __________________
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free =13%)
    Jan '12: Biopsy: 1/12 = G7 (3+4) & 5/12 = G6
    March '12: Robotic RP: Left: PM + EPE => MD excised additional adjacent tissues
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    uPSA Range: 0.017 - 0.039 at 105 Months Post Op: Mean = 0.023 (n = 25)
    LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%) ED = present

     
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    Old 05-15-2020, 07:48 AM   #5
    DjinTonic
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    Re: Up-Date From Big Al Latest Results uPSA

    Hi BigAl. Nice to hear from you again!. Here are my thoughts on your PSA. Keep in mind that you were G7 (4+3) pT3a, with both a positive margin (even if small) and EPE (even if only focal), so of course you want to be on the alert for a rising PSA. Your doc was right to re-test the 0.07 result. Although you could look at the 0.07 and 0.06 as "outliers," you could also say that your PSA has risen and the 0.03 is an outlier! In any case, it's clear your PSA is no longer undetectable to your test.

    For a guy without a prostate and over 1.5 years of a PSA of 0.02 or less, I can't see why your PSA would bounce around so much at the second decimal now. Whatever test you use, make sure it's being done with the same assay at the same lab.

    There is uncertainty inherent in the right-most digit of any lab test, and since you have only one digit of good information, doubt will remain until you have several more readings. I suggest you switch to Labcorp's 3-digit uPSA test rather than Quest's 2-digit. You will have two benefits. First, you'll have a better sense of what your actual PSA currently is. Secondly, you'll be able to better monitor your trend. My general advice is to use a PSA test with one decimal place more than the decimal place you want to track. If you round a 3-decimal test to 2 decimals, you will have much more reliability.

    Then, if you are witnessing a rise, whether slow or not, you can discuss with your docs what the source may be (leftover healthy tissue, new malignant growth, or a combination.) A rising PSA may warrant a Decipher test of your RP tissue to learn the genomic risk of metastasis of you cancer,

    I assume your RO will want to keep monitoring, but it could be a while before you establish a reliable trend using your current test.

    Keep us posted,

    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, negative 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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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    Old 05-16-2020, 06:53 PM   #6
    Insanus
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    Re: Up-Date From Big Al Latest Results uPSA

    My guess is your hydration is effecting the concentration.

     
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    Old 05-17-2020, 05:53 AM   #7
    Prostatefree
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    Re: Up-Date From Big Al Latest Results uPSA

    Also, medications (statins) can reduce PSA as well as mega dosing some vitamins and supplements.

    Review your medications and any new diet habits with your urologist.

     
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    Old 05-17-2020, 11:12 AM   #8
    Bigalcalbisque
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    Re: Up-Date From Big Al Latest Results uPSA

    Thanks for all the great advice everyone, my vitamin regime and hydration has been extremely consistant for at least the last 5 years. Even though I certainly take note of that possibility, I don't think that would apply to me. My vitamin routine is exact and due to Diverticulosis my hydration is extremely constant at 64 ounces of water a day, the only thing that I have added to the water for the last several months is Arizona Ginsing Tea to give my water a little flavor. Also I do not take any kind of Anti-depressants other than an occaisional Valium (5mg) for sleep.
    I will be talking to my Radiologist soon. I think I am going to keep the PSA testing at the current level that I am doing just because I don't want to start stressing about little fluctuations one way or the other as it seems that I am fluctuating anyway, I do get tested every 3 months so I think that active surveilance will probably work the best. I am curious though at the levels that I am at, should I be worrying about my PC spreading to other areas??? any thoughts? I will bring that up to my Radiologist but am just curious if other scans, etc would be advisable at this point.
    Hi DjinTonic, glad to see you are still very active!
    Thanks, Al
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

    Last edited by Bigalcalbisque; 05-17-2020 at 11:16 AM. Reason: need to add info

     
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    Old 05-17-2020, 07:48 PM   #9
    IceStationZebra
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    Re: Up-Date From Big Al Latest Results uPSA

    Can you ask for the labcorp test that goes out to .006? That might help add clarity.

     
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    Old 05-18-2020, 06:06 AM   #10
    Prostatefree
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    Re: Up-Date From Big Al Latest Results uPSA

    Quote:
    Originally Posted by Bigalcalbisque View Post
    Thanks for all the great advice everyone, my vitamin regime and hydration has been extremely consistant for at least the last 5 years. Even though I certainly take note of that possibility, I don't think that would apply to me. My vitamin routine is exact and due to Diverticulosis my hydration is extremely constant at 64 ounces of water a day, the only thing that I have added to the water for the last several months is Arizona Ginsing Tea to give my water a little flavor. Also I do not take any kind of Anti-depressants other than an occaisional Valium (5mg) for sleep.
    I will be talking to my Radiologist soon. I think I am going to keep the PSA testing at the current level that I am doing just because I don't want to start stressing about little fluctuations one way or the other as it seems that I am fluctuating anyway, I do get tested every 3 months so I think that active surveilance will probably work the best. I am curious though at the levels that I am at, should I be worrying about my PC spreading to other areas??? any thoughts? I will bring that up to my Radiologist but am just curious if other scans, etc would be advisable at this point.
    Hi DjinTonic, glad to see you are still very active!
    Thanks, Al
    Statins are cholesterol controlling drugs.

    Managing hydration formulas also includes physical activity and diet. Maintaining the same amount of water intake while increasing; activity; caffeine; alcohol; can lead to dehydration. Diuretics used to control high blood pressure can also induce dehydration if not compensated for in your lifestyle.

    Simplest fastest way to watch for dehydration is your urine color. Color of lemonade is good. Color of apple juice or darker is dehydration. It can change quickly. Be aware coming up to the test.

    It is common for men to unconsciously begin to manage incontinence after RP by drinking less. The amount you drink to remain hydrated must vary with activity and other environmental factors.

     
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    Old 05-18-2020, 08:46 AM   #11
    Bigalcalbisque
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    Re: Up-Date From Big Al Latest Results uPSA

    Saw Statins, immediately thought Anti-Depressant, I don't need them anyway, that part of me is good (cholesterol). My pee color is all over the map (not literally) I take vitamins and supplements that alone will change the color even if I am not dehydrated so I do understand your thoughts, no huge change to exercise in 5 years but I have been walking a lot more since March 20th. I do Yoga 1-3 times a week for an hour but that is normal. So, I am just going to assume that whatever is causing the "Bounce" is an unidentifiable foreign object (UFO).
    Or swamp gas

    Anyway, I was happy to see the bounce go down. Again, I don't think I need to change the testing as I don't want to be obsessing the rest of my life should my PSA go up from 0.030 to 0.031 on my next test ad nauseum!

    I stongly feel that to what ever degree, my emotional state and attitude are the 2 best personal friends I have.

    Thanks again to all who took time out of their day to respond and educate me.
    Al
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

     
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    Old 05-18-2020, 09:22 AM   #12
    DjinTonic
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    Re: Up-Date From Big Al Latest Results uPSA

    Quote:
    Originally Posted by Bigalcalbisque View Post
    Saw Statins, immediately thought Anti-Depressant, I don't need them anyway, that part of me is good (cholesterol). My pee color is all over the map (not literally) I take vitamins and supplements that alone will change the color even if I am not dehydrated so I do understand your thoughts, no huge change to exercise in 5 years but I have been walking a lot more since March 20th. I do Yoga 1-3 times a week for an hour but that is normal. So, I am just going to assume that whatever is causing the "Bounce" is an unidentifiable foreign object (UFO).
    Or swamp gas

    Anyway, I was happy to see the bounce go down. Again, I don't think I need to change the testing as I don't want to be obsessing the rest of my life should my PSA go up from 0.030 to 0.031 on my next test ad nauseum!

    I stongly feel that to what ever degree, my emotional state and attitude are the 2 best personal friends I have.

    Thanks again to all who took time out of their day to respond and educate me.
    Al
    BigAl, the Lacorp uPSA test has an inherent variability of +/- 0.002 when testing around the 0.010 mark and using +/- 2 standard deviations (which encompasses 95% of results). That means Labcorp could immediately repeat the test with the same blood I had sent and get a difference of 0.004 between the two runs. Thats why no one sweats small variations with it.

    A change from, as you say, 0.030 to 0.031 woud be no change. My uro wrote "excellent" in the patient portal when I went from 0.015 to 0.016, for example. On the other hand a change from 0.02 to 0.07 (or 0.020 to 0.070 with a 3-decimal test) is concerning.

    The difference is that variability is in the thousandths and not the hundredths, resulting in much LESS anxiety.

    I don't think hydration could account for your variability.

    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, negative 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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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    Old 05-19-2020, 01:46 AM   #13
    Prostatefree
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    Re: Up-Date From Big Al Latest Results uPSA

    To keep the language clear, in PCa PSA lingo you did not experience a bounce.

    If you want to test your use of supplement's effect on your PSA stop them for 3 months until after the next test. This is only useful if you plan an early response to a recurrence and want an unadulterated PSA to guide you.

    If you plan a more conventional response, waiting until the 0.1 threshold, time will sort this all out. Supplements themselves will not stop an actual recurrence. They will only mask it.

    Beware of mega dosing for extended periods of time. It is not healthy and will stress and threaten the function of critical vital organs. Our bodies are not designed for large volumes of synthesized and concentrated chemicals that are intended as trace elements in our diet.

     
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    Old 05-19-2020, 07:17 AM   #14
    Bigalcalbisque
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    Re: Up-Date From Big Al Latest Results uPSA

    This is Googles definition of a "PSA Bounce" from Radiation therapy, which I didn't have. What definition would I use other than this? Also my vitamin supplement has been constant for at least 5 years as mentioned earlier, so even though I may be taking some that are higher than required, all of my Dr's have what I take on file. I will go over that with my radiologist when I see him.

    PSA bounce ( bownts) A brief rise and then fall in the blood level of PSA (prostate-specific antigen) that occurs in some patients 1-3 years after receiving radiation treatment for prostate cancer. PSA bounce does not mean that the cancer has come back.

    So, I feel logically that my "fluctuation in PSA is either caused by Cancer Recurrance (odd that it would go down) or some other unknown entity that I am not aware of at the moment.

    Thanks for your input! Al
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

     
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    Old 05-19-2020, 02:37 PM   #15
    Prostatefree
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    Re: Up-Date From Big Al Latest Results uPSA

    Quote:
    Originally Posted by Bigalcalbisque View Post
    This is Googles definition of a "PSA Bounce" from Radiation therapy, which I didn't have. What definition would I use other than this? Also my vitamin supplement has been constant for at least 5 years as mentioned earlier, so even though I may be taking some that are higher than required, all of my Dr's have what I take on file. I will go over that with my radiologist when I see him.

    PSA bounce ( bownts) A brief rise and then fall in the blood level of PSA (prostate-specific antigen) that occurs in some patients 1-3 years after receiving radiation treatment for prostate cancer. PSA bounce does not mean that the cancer has come back.

    So, I feel logically that my "fluctuation in PSA is either caused by Cancer Recurrance (odd that it would go down) or some other unknown entity that I am not aware of at the moment.

    Thanks for your input! Al
    I did not see where you had radiation treatments in your signature. A bounce is not expected after RP and the term is not used to describe a change in PSA after RP. It applies only to those having radiation therapy for PCa.

    Your change is unusual in my experience, which is limited. I am not a doctor. Something isn't adding up.
    __________________
    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;
    6-30-20 PSA less than 0.02, zero club 4 yrs

     
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