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04/02/2011 06:02 PM

PSA Recurrence After Prostatectomy

prostatedoc
Posts: 39
New Member

HI everyone:

A new friend from the group asked me for my thoughts on PSA recurrence after prostatectomy. I have put together a post in my blog for all that are interested:

http://myprostatedoc.blogspot.com/2011/04/psa-recurrence- after-prostatectomy-good.html

Hope you find it useful!

prostate doc

myprostatedoc.blogspot.com

The blog is not a medical practice and cannot provide specific medical advice. This information should never be used to replace or discount the medical advice you receive from your physician

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04/02/2011 06:39 PM
canadianlyme
canadianlyme  
Posts: 71
Member

thank you for this explanation of a oorly understood issue.

Does the term 'psa recurrence'apply to levels as low as .008 ?


04/02/2011 11:44 PM
az4peaks
az4peaks  
Posts: 83
Member

Hi canadianlyme,- I feel confident that prostatedoc will concur with the fact that a PSA reading of 8/1000th (.008) of a nonogram would NOT be considered a recurrence of PCa. See the following information contained in a previous Post I made on this general subject. I will be interested in his response, if any different. -John@newPCa.org (aka) az4peaks

Hi ALL, - I have answered this same question on many occasions. The use of Hyper or Ultra-sensitive PSA tests for the ROUTINE monitoring of PSA for low and moderate risk patients often creates UNNECESSARY PSA anxiety.

CLINICALLY, an "undetectable" PSA is considered to be LESS THAN 0.1 ng/ml. This is reported as <0.1 ng/ml on the STANDARD PSA test, which reports results to the 10th of a nonogram. Originally, it was 0.2, because that was the reliable sensitivity of the test first available, but most STANDARD assays today are reliable to 0.1 ng/ml and therefore it has become the most widely accepted standard for the term "undetectable" in both screening and routine monitoring.

The subsequent development of Hyper-sensitive or Ultra-sensitive PSA assays, that read results to the hundredths or thousandths of a nanogram tend to confuse many laymen, because they report more sensitive, TECHNICALLY “detectable” readings, but for CLINICAL and treatment purposes, any reading under 0.1 ng/ml (.001 to .09) is, generally, considered to be an "undetectable" PSA.

Because of non-biological variations that can naturally occur in readings, it is important that any reading of 0.1 be verified by repetition. For this reason, PSA biochemical "failure" has been established at 0.2 ng /ml. and most responsible Physicians do not take any action until such more reliable readings are present. With exceptional caution, some Physicians may not confirm treatment failure until a rising PSA reaches between 0.2 & 0.4 ng/ml.

The exception to these general "rules" are in cases where particularly close monitoring may be deemed to be advisable, such as ADVANCED PCa or patients at extremely HIGH RISK of recurrence, where an Oncologist, in a specific instance, may adjust treatment at a reading of 0.05 ng/ml on the Hyper or Ultra-sensitive test. But these are UNUSUAL exceptions, even then and don't apply to those of us being ROUTINELY monitored after treatment.

Some of these terms are used interchangeably within the medical profession, where they are generally understood, because of the context in which they are used, but that can certainly confuse the average patient, who is typically a layman. So, if you are not sure of a meaning or have a question, do ask for clarification. I hope this rather lengthy answer is understandable, but if not contact me again for clarification and I will try to do better. – John@newPCa.org (aka) az4peaks

P.S. The following is an article from Johns Hopkins on the subject: LISTEN TO THE EXPERTS!

A Publication of the James Buchanan Brady

Urological Institute Johns Hopkins Medical Institutions

Volume V, Winter 2000

PSA Anxiety: The Downside of Ultra- Sensitive Tests

You've had the radical prostatectomy, but deep down, you're

terrified that it didn't work. So here you are, a grown man, living in fear of a simple blood test, scared to death that the PSA- an enzyme made only by prostate cells, but all of your prostate cells are supposed to be gone -- will come back.

Six months ago, the number was 0.01. This time, it was 0.02. You have PSA anxiety. You are not alone. This is the bane of the hypersensitive PSA test: Sometimes, there is such a thing as too much information.

Daniel W Chan, Ph.D., is professor of pathology, oncology, urology and radiology, and Director of Clinical Chemistry at Hopkins. He is also an internationally recognized authority on biochemical tumor markers such as PSA, and on immunoassay tests such as the PSA test. This is some of what he has to say on the subject of PSA anxiety:

The only thing that really matters, he says, is: "At what PSA

levels does the concentration indicate that the patient has had a recurrence of cancer?"

For Chan, and the scientists andphysicians at Hopkins, the number to take seriously is 0.2 nanograms/milliliter. "That's something we call biochemical recurrence. But even this doesn't mean that a man has symptoms yet. People need to understand that it might take months or even years before there is any clinical physical evidence."

On a technical level, in the laboratory, Chan trusts the

sensitivity of assays down to 0. 1, or slightly less than that. "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."


04/04/2011 09:26 PM
prostatedoc
Posts: 39
New Member

Hi Guys,

Although I am not allowed to reply to individual scenarios, I agree with what you are saying. The ultrasensitive test. although sometimes useful, is most of the time just a stress provoker. Stick to the guidelines that I mentioned and you should be ok. As always, the advice I provide here is not a medical practice and should NEVER replace or discount the advice of your physician.

Prostate Doc

myprostatedoc.blogspot.com

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