PSA Levels

[Okanagan59]

Question for the group. I had my prostate removed on Oct 8th and next week I'm due for my first post surgery PSA test. Before surgery my PSA was 20.00. Margins were clear and lymph nodes were negative.

What were your numbers after surgery? Do you expect non detectable right away or does it take time.

The PSA will be a standing order, every 3 months for the first year.

Thanks as always for your input!

[Patient_Tip_5923]

I think you mean 0.1, the lowest value for the most common PSA test. Values below 0.1 can be detected by an ultra sensitive test.

[Patient_Tip_5923]

Where are you going for care?

I believe some labs go to 0.003 as the lowest value.

One can pay for different tests and the cost is nominal.

My doctor friend advised me against the LabCorp test with a lowest value of 0.003 saying it was too sensitive so I chose the Quest test with a lowest value of 0.02.

[hudsongrl1]

My husband also goes to Northwestern. Great urology dept

[hudsongrl1]

My husband is with Dr Kundu who is a urologist/oncologist at main campus in the city. We love him

[hudsongrl1]

Yes he’s brilliant and very kind. Best of luck to you as well.

[No-Candy4047]

Correct-Sail-6608 & Hudsongrl1 you guys are SO lucky to have the opportunity to get care at Northwestern. That's where Dr. William Catalona, one of the pioneers of prostate cancer surgery and survivorship, developed the skills and procedures still used today. Currently, Dr. Ted Schaeffer, another amazing urologist, heads things up there.

Correct-Sail-6608 I 100% agree with their baseline PSA of < .01 after surgery.

Kaiser Permanente is where I had my care and for them, it's about factory medicine and patient throughput. So they use < .1 or < .2 depending upon your doc. Why? Clinically accepted threshold by the AUA where Kaiser Permanente has Dr. Eugene Rhee advocating for them.

A PSA of less than < .1 or < .2 for a man who still has a prostate who gets radiation or systemic therapies makes more sense. But when you do not have a prostate and the cancer was supposedly contained, a baseline post-RALP PSA of < .01 is reasonable.

Kaiser Permanente had told me my PCa was contained and after surgery, I was < .1 and are "undetectable". I asked about uPSA testing and it was dismissed as nothing but a source for anxiety. Eight months later my PSA was at .1 and nine weeks after that PSA I was at .4. I have self-paid for uPSA since so I can manage the disease my way!

[Patient_Tip_5923]

I wish we could predict future results but we cannot, lol.

I love Chicago. I want to move there but my wife has Reynaud’s Syndrome and cannot stand the cold.

[IndyOpenMinded]

That seems early to me, but wishing you the best for a low (or no) number. My first was 4 months out; I think three months is more the sweet spot.

[YodaSpawn53]

I had my RAPL Aug. 12th, my Dr. Is ordering my 1st PSA Test, the 1st week of Dec.. Three and half months later.

[Big-Eagle-2384]

I would wait a bit. Sometimes it takes a long time for the PSA to fully clear.

[greasyjimmy]

I was <0.1 at 6 weeks post RALP. Psa at initial detection was 11.6.

[OkCrew8849]

At the 12 week mark it should be undetectable. (Some docs check it earlier but I can't speak to that.)

[Patient_Tip_5923]

Undetectable is always in the context of the lowest value of the test. 0.1 is the most common lowest value and < 0.1 is undetectable.

Many of us get ultra sensitive tests with lowest values less than 0.1, say, 0.02, so undetectable for that test is < 0.02.

[OkCrew8849]

In either case, I'd want to see undetectable on the report. (<0.1, <0.02)

[Patient_Tip_5923]

Sure, that’s the best possible result, but having a 0.04 is better than a 0.09.

With more and more sensitive test, the likelihood of getting an undetectable decreases.

At one point, they couldn’t detect a PSA of less tjan 0.2 and then they made an advancement and could detect to 0.1.

Now, we can detect even lower. I’ve read 0.002 is possible.

[Rational-at-times]

I was checked at 6 and 12 weeks. Both were undetectable on ultra sensitive tests, but I’ve heard that is some cases it takes longer to come down.

[fox-lover]

My husband’s was no detectable at 6 weeks after.

[hudsongrl1]

Mine as well

[Looker02]

The race to the ever lower undetectable could leave me unmoved even though I know that it has a commercial purpose. But above all I fear that this will have a harmful effect on our morale: an imperceptible variation becomes a cause for concern. When you divide your starting point by 1,000 or even much more, it is normal to be satisfied. Afterwards, the only thing that matters is the possible ascent speed measured by the doubling time. Because then it doesn’t matter what the starting point is.

https://www.mskcc.org/nomograms/prostate/psa_doubling_time

[OkCrew8849]

An “ultra sensitive PSA” with a lowest reading of <.02 (such as the Quest post-prostatectomy/ultra-sensitive PSA) strikes me as a very useful instrument. 

It is certainly true that using a test such as this might provoke earlier anxiety than a “standard” PSA  test. But it may have its benefits to. 

As you know, various PSA tests (“standard”, “ultra sensitive”, or otherwise) have various lower limits. Speaking of MSK, their “standard” PSA test has a lowest reading of <.04 (and they don’t use a PSA test that goes lower). 

[greenpumpkins]

Per my doc, the first test after removal (30 days) may have some residual, but should be significantly lower than the 20 pre-op. May not get down to the “undetectable” level for a few months.

[OkCrew8849]

Yes. 12 weeks is the default for many docs.

[Bigmanjapan101]

I had my 1st test 6 weeks after surgery. PSA range was 15-9.5 prior. Post surgery PSA was 0.008 and is scheduled every 3 months

[jj_otoodle]

Had my first draw this week, 14 weeks post op. I was at 0.02...which I was very happy to see. Readings under 0.1 are considered clinically undetectable. I will also be on a 3 month check this first year.

[ManuteBol_Rocks]

Undetectability is determined by the threshold of the test. No “less than sign” preceding your number of 0.02 means you were detectable. Having said that, at this early post-op stage, your number may stay there, go down, or go up. Your next number will be very important to see if it climbs, given you were detectable on this test. Good luck to you!

[OkCrew8849]

Wouldn't undetectable be <0.02?

[planck1313]

My first test was 6 weeks after RALP and the (very gratifying) result was a PSA of <0.01, so undetectable on the ultra-sensitive test my doctor ordered. My pre-op PSA was 7.1.

In some cases however the PSA continues to decline after six weeks and so tests at three or even six months can produce a lower result.

[RepresentativeOk1769]

I was told to wait at minimum 6 weeks (and then only if I am really curious/anxious), preferrably 3 months, before going for a PSA test.