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Cancer: Prostate Message Board

Cancer: Prostate Board Index

[QUOTE=Kaseyjcf;4248954]...are getting better, however we do not know if we should be overly concerned about his follow up PSA's. He had 1 done in December and his number was 0.06, then he had another 1 done this month and it was 0.05. Isn't that kinda high after surgery being less than a year ago or are we hearing the wrong info? [/QUOTE]


[U]Short answer[/U]: Those are excellent results! With his cancer contained within his prostate (which you also previously reported), he should continue to get excellent results like this forever! Congratulations!

[U]Longer answer[/U]: Pay close attention to the number of decimal places in this discussion...

There are small traces of PSA which can be produced by benign tissue left behind after surgery which can be detectable with the "[COLOR="Purple"][B]ultra-sensitive[/B][/COLOR]" PSA test. For example, the neurovascular bundles (which you previously reported were 'saved' in your husband's surgery) can be a source of [U]detectable[/U] PSA. There are also other sources of [I]very [/I]small amounts of PSA in the body.

There are two main types of PSA tests. [U]First[/U], there is the "[COLOR="DarkOrange"][B]standard[/B][/COLOR]" test which has a lower detection limit (LDL) of 0.1 ng/mL. If any PSA is present in the blood sample below that level, it is reported simply as "<0.1 ng/mL" (less than 0.1) because the test methodology is not sensitive enough to accurately measure below the lower detectioin limit. [U]Second[/U], there is the "[COLOR="purple"][B]ultra-sensitive[/B][/COLOR]" PSA test which gives more precise results with a smaller LDL. There are actually several types of "[COLOR="purple"][B]ultra-sensitive[/B][/COLOR]" tests with differing LDLs, but the most common ones have a LDL of either 0.04 or 0.01 ng/mL. Your husband, with reported levels of 0.06 and 0.05 ng/mL, has obviously had an "[COLOR="purple"][B]ultra-sensitive[/B][/COLOR]" test.

There is a little controversy among doctors as to whether to prescribe the "[COLOR="purple"][B]ultra-sensitive[/B][/COLOR]" test or the "[COLOR="darkorange"][B]standard[/B][/COLOR]" test for post-RP patients; the controversy mainly surrounds men who have had [I]no margin issues [/I]and the cancer appears to be fully [I]contained[/I]. For these men, there is only a tiny chance of recurrence, and so it is felt (by [I]some [/I]doctors) that the "PSA Anxiety" that the patient may experience ([I]like you have now experienced[/I]) as a result of the [U]natural variation of results within the detectable range[/U] of the "[COLOR="purple"][B]ultra-sensitive[/B][/COLOR]" test is reason enough to prescribe only the "[COLOR="darkorange"][B]standard[/B][/COLOR]" PSA test. On the other hand, other doctors simply feel that more data is better.

The American Urological Association (AUA) has defined biochemical recurrance as a PSA value >0.2 ng/mL (greater than 0.2), followed by a subsequent result >0.2 ng.mL. Reference: "Prostate Specific-Antigen Best Practices Statement: 2009 Update") These results would detectable with either the "[COLOR="darkorange"][B]standard[/B][/COLOR]" test or the "[COLOR="purple"][B]ultra-sensitive[/B][/COLOR]" test. So, your husband's detectable results are far below the AUA threshold defined for recurrence.

Bottom line: Your husband's doctor appears to follow the protocol of prescribing the [COLOR="purple"][B]ultra-sensitive [/B][/COLOR]test post-PR, no matter what the pathology results were. Your husband's results (including the slight variation down, but it could also vary upwards next time) are detectable with the [COLOR="purple"][B]ultra-sensitive [/B][/COLOR]test, but not with the [COLOR="darkorange"][B]standard [/B][/COLOR]test...and that is quite natural and expected. He's doing great!

By the way, next time he is in to see the doctor, have him confirm my comments with the doctor. I'm confident that he will essentially say the same thing. Also by the way, my doctor follows the protocol of prescribing the [COLOR="darkorange"][B]standard [/B][/COLOR]test for patients with organ-confined post-RP results (like me) in order to help patients avoid the "PSA Anxiety", and so my results have consistently been reported as "<0.1 ng/mL."

hope this helps...

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