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  • #1

    PSA test questions

    I Just got my first PSA test five weeks out from my RP. it was < 0.1. So that is good. I noticed a lot of people here getting tests another decimal out. Where do you get those tests at. Does my hospital have to send the blood out to a better laboratory?

    I have an appointment next Monday and I wanted to get educated a little on if a better test is necessary and where I get one?
    born 1958
    PSA History:
    1/22/10 -7/16/21 1.7-2.3
    01/10/2022 2.2
    07/08/2022 1.7

    Biopsy 9/2021 slides read by local urology group
    unfelt small leasion found in 3 sectors
    I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
    K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
    L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
    Gle 3+4

    Decipher score .26 Low Risk

    Johns Hopkins, Dr. Epstein read of slides 10/14/2021
    I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
    K. Gle 3+3 (group 1), involving 10% of one (1) core
    L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core



    MP MRI 12/10/2021 results:
    1. No index lesion identified. MRI findings
    PI RADS 2 abnormality (low likelihood of clinically
    significant prostate cancer).

    October 2022:
    biopsy 16 cores. 2 G3+4 one G3+3
    MRI: pirads 4 now
    Decipher .46 Intermediate risk

    RALP 12-14-22
    pT2 pNX, adenocarcinoma, G7 (3+4), 6-10% Pattern 4
    EPE SM SVI LVI BNI all neg., no IDC or cribriform glands
    5.2 x 5.1 x 3.7 cm, 45 g, tumor involvement: 6-10%
    Largest of 3 nodules 2.3 x 1.4 x 1.0 cm, nodule with most Pattern 4: 30%​
    Tags: None
  • #2
    Different labs test to different values. Mayo Clinic’s lab uses <0.10, Cleveland Clinic tests uses <0.03, Quest Labs test to <0.02. LabCorp is going to be the nationwide lab that provides the lowest value. I seem to remember LabCorp uses <0.01 or lower for their ultra sensitive test.

    I would be happy with any test standard <0.03.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM &amp;lt;5%, Right side negative.

    3/6/19. Post surgery Pathology Report - Grade Group 4 Intraductal Carcinoma
    T3aNO, <1 mm non focal EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.
    7 Nodes, SV, SM, PNI, and BNI were negative.
    LVI and Cribriform pattern present.
    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (25 days)
    4/25/19. <.03. (2 months)
    5/25/19 <.02 (3 month)
    5/20/22. < .02 (39 months). T=37
    11/7/22. <.02 (45 months) T=54

    3 Part Modality Treatment Completed

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery his #41st in US.
    ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
    ADT - 5/19- 5/21 Eligard and Casodex.


    3 Part Modality Treatment Completed

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic, Dr. Kaouk, surgery #41 in US.
    ART - 7/25/-9/25 2019 (78 Gy, yes, I glow in the dark).
    ADT - 5/19- 5/21 Eligard and Casodex.

    ​

    Comment

    • #3
      You'd have to inquire whether your hospital also has a more sensitive PSA test. Otherwise Quest's ultrasensitive test reports <0.02 as its lowest value, as Duck2 mentioned, and Labcorp's ultrasensitive reports down to <0.006.

      If you do get a doc to order such a test or arrange one yourself, I suggest always reminding the tech who draws you blood that it is for the ultrasensitive PSA test: all labs that offer an ultrasensitive PSA test also have the "standard" PSA test that you had, and it's not difficult for a tech to mix them up when doing the paperwork.

      Djin
      Last edited by DjinTonic; 01-18-2023, 04:57 AM.
      69 yr at diagnosis, BPH x 20 yr, 9 (!) neg. biopsies, PCA3-
      7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
      6-06-17 Nodule on right + 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 neg. 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) acinar adenocarcinoma
      5% of prostate (4.5 x 5 x 4 cm, 64 g) involved
      Dry; ED OK with sildenafil
      11-10-17 Decipher score: 0.37, Low Risk:
      5-yr met risk: 2.4%, 10-yr PCa-specific mortality: 3.3%      		 9-16-17 (5 wk) PSA <0.1
      (3 m ) 0.010
      (6 m ) 0.009
      (9 m ) 0.007 (nadir)
      (1 yr.) 0.018 (?)
      (13 m) 0.013 (retest)
      (15 m) 0.012
      (18 m) 0.015
      (21 m) 0.015
      (2 yr. ) 0.016
      (28 m) 0.015
      (34 m) <0.014
      (40 m) 0.037 (?)
      (43 m) 0.020
      (46 m) 0.018
      (52 m) 0.023
      (5 yr) 0.038
      (63 m) 0.036
      (66 m) 0.049

      Comment

      • #4
        Congrats on the low test.

        Comment

        • Philtoo
          #4.1
          Philtoo commented
          01-18-2023, 07:25 AM
          Editing a comment
          Thanks brother! Wishing you the best outcome also.
      • #5
        Duck and Djin, Thanks for the information. Are the most sensitive tests necessary to keep on top of this do you think. It seems like a lot of people here are looking at .0x not .x as the number to monitor.
        born 1958
        PSA History:
        1/22/10 -7/16/21 1.7-2.3
        01/10/2022 2.2
        07/08/2022 1.7

        Biopsy 9/2021 slides read by local urology group
        unfelt small leasion found in 3 sectors
        I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
        K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
        L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
        Gle 3+4

        Decipher score .26 Low Risk

        Johns Hopkins, Dr. Epstein read of slides 10/14/2021
        I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
        K. Gle 3+3 (group 1), involving 10% of one (1) core
        L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core



        MP MRI 12/10/2021 results:
        1. No index lesion identified. MRI findings
        PI RADS 2 abnormality (low likelihood of clinically
        significant prostate cancer).

        October 2022:
        biopsy 16 cores. 2 G3+4 one G3+3
        MRI: pirads 4 now
        Decipher .46 Intermediate risk

        RALP 12-14-22
        pT2 pNX, adenocarcinoma, G7 (3+4), 6-10% Pattern 4
        EPE SM SVI LVI BNI all neg., no IDC or cribriform glands
        5.2 x 5.1 x 3.7 cm, 45 g, tumor involvement: 6-10%
        Largest of 3 nodules 2.3 x 1.4 x 1.0 cm, nodule with most Pattern 4: 30%​

        Comment

        • #6
          The ultrasensitive test is sometimes referred to as a post prostatectomy PSA test. My current Uro group does their own in house testing with a sensitivity down to .008, though I do not know which assay they use. My Uro said they always use ultrasensitive for all their patients. I've read that the standard PSA test is used for those who had primary radiation, as the post Tx PSA values fluctuate, but after RP there should be no PSA, as in zero, or as close to zero as they can measure.
          Late 2012: PSA 4, age 62 all DRE's 'normal'
          Early 2014: PSA 9.5, TRUS biopsy (false) negative
          2015: PSA's 12 & 20, lots of Cipro ... Mar '16: PSA 25, changed Urologist

          Jun'16: MRI fusion biopsy, rt base, 2ea 15-40-100% G8(4+4)
          Aug'16:DVRP, "broad cut" 11 LN-, neg margins, gland 53g, 25% involved
          multifocal EPE, PNI, BNI, bilateral SVI, pT3b N0          		 Dec 2016: Mrs: Dx stage 4 NHL/DLBCL, Primary Bone Lymphoma
          spinal RT boost+6X R-CHOP21+6X IT MTX via LP.
          Remission ended 2020, Follicular NHL. Currently active surveilance.

          Mar 2020: older adult son, T-cell acute lymphoblastic leukemia (TALL)
          Hyper-CVAD + pegaspargase, RBC transfusions in NYC amid COVID-19
          Bone marrow transplant Oct 2020, currently in Remission
          Jan'17: began Lupron ADT, uPSA's ~.03
          May'17: AMS800 implanted, revised 6/17
          Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
          Jan 2018-July 2022: PSA's <0.008, T ~ 50
          Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis          		 June 2020: younger adult son, small bowel resection
          adenocarcinoma of lower ileum (SBA) w/+lymph node, stage T3a-N1
          Adjuvant chemo: 12x FOLFOX, currently in Remission

          "Everyone you meet is fighting a battle you cannot see"

          Comment

          • #7
            Thanks Rob. I will ask them about this.
            born 1958
            PSA History:
            1/22/10 -7/16/21 1.7-2.3
            01/10/2022 2.2
            07/08/2022 1.7

            Biopsy 9/2021 slides read by local urology group
            unfelt small leasion found in 3 sectors
            I. Gle 3+3 (SUP Grp 1) .5mm involving(1% & PIN)
            K. a Gle 3+4 (SUP Grp 2)2 mm involving(10%)
            L. Gle 3+4 (SUP Grp 2)1.5 mm involving(5% patchy)
            Gle 3+4

            Decipher score .26 Low Risk

            Johns Hopkins, Dr. Epstein read of slides 10/14/2021
            I. Small focus of prostatic adenocarcinoma, Gleason Score 3+3 (group 1), involving less than 5% of one (1) core
            K. Gle 3+3 (group 1), involving 10% of one (1) core
            L. , Gle 3+3 (group 1), discont. involving 20% of one (1) core



            MP MRI 12/10/2021 results:
            1. No index lesion identified. MRI findings
            PI RADS 2 abnormality (low likelihood of clinically
            significant prostate cancer).

            October 2022:
            biopsy 16 cores. 2 G3+4 one G3+3
            MRI: pirads 4 now
            Decipher .46 Intermediate risk

            RALP 12-14-22
            pT2 pNX, adenocarcinoma, G7 (3+4), 6-10% Pattern 4
            EPE SM SVI LVI BNI all neg., no IDC or cribriform glands
            5.2 x 5.1 x 3.7 cm, 45 g, tumor involvement: 6-10%
            Largest of 3 nodules 2.3 x 1.4 x 1.0 cm, nodule with most Pattern 4: 30%​

            Comment

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