Hypersensitive PSA. Where can I get it done.

My lab only does the ultra sensitive PSA.  I have seen some guys with the hyper sensitive test.  What lab does this?  I live in Columbus, Ohio....I know Lab Corp. is here but don't know how to find anyone else.

thanks

It's your choice of course, but why would you need hypersensitive PSA tests?

 

Here is why.

http://urology.jhu.edu/newsletter/2012/prostate_cancer_2012_14.php

 

Chris, a valid question that I would ask, one that you may want to ask yourself, is what would YOU actually DO with that increased amount of data?

Would you exercise more, knowing that exercise helps to slow PC progression?  Well, while I don't know your exercise routine in specific, the vast majority of American men should reduce their weight and exercise more for PC reasons, heart reasons, and other health reasons.

Would you change your diet, knowing that the diet/nutrition choices you make can either feed or retard cancer growth?  Well, I don't know your diet habits now, but the vast majority of Americans, dietary choices and physical activity are the most modifyiable determinants of cancer risk (multiple cancers...and most of us here need to be thinking about the next cancer we might be getting).

Would you start secondary therapy?  Probably not with today's therapy modes.

Would you worry and have anxiety for what has a sizable probability of not being a real issue?  Probably.

Think before you jump.

Chris:

You did read these sentences carefully:

“All of the men had PSA lower than 0.1 ng/ml after surgery, yet one-third of them later had biochemical recurrence, while the others kept having undetectable PSA for many years after surgery.” The men were similar in age, race, and had negative surgical margins after surgery; however, the men whose PSA levels went up had a higher pre-surgical PSA, clinical and pathological stage, and Gleason grade than the men whose levels remained very low."

I find this article to be like many of the Discovery articles, a digest version of a much bigger study and very incomplete in substantive details. The men who eventually had a detectable PSA were higher in pre-surgical PSA How High? Greater than 10? Had a higher clinical and pathological stage. Again, How High? Same for the Gleason grade. After reading HW entries for a while a lot of guys here have more than T2 clinical and pathology stages and Gleason 7+ but still have a long string of <0.1 undetectable PSA for multiple tests post-RP. Partin appears to indicate that a high risk patient who has seeming low risk post surgical PSA might benefit by an ultrasensitive (3 digit) test to see if they might develop biochem recurrence.

If the article said that Gleason 6 pathology scores with low PSA and T2 staging appeared to have recurrences I would pay closer attention to the warning and perhaps look for this test. Suppose you find a place to do the ACCU Psa test and you come back with a > 0.0003 result. Are you going to do radiation right away? Look at HT? Worry like crazy? Perhaps Partin is addressing the issue of those with G7 and other higher type features that seem to be in the clear but all of a sudden start to have rising PSA scores. This eliminates that "all of a sudden" factor and lets doctors look around the corner a bit for men with higher pre-surgical profiles who might be at risk for a recurrence.
That's my .0002 cents on the topic.
Mike S.

To put it the way one oncologist said it ~ "PSA fluctuates, sometimes in the same hour that two tests are taken." In other words if you have a PSA drawn at 8:00am, it will likely not precisely match a second test at 5:00pm at the same lab. I respect Alan Partin a lot. But at one point is this just a preliminary investigation (which that article is) versus a piece of information you take action with. I understand the theory, but that's all it is until a greater scale trial is completed. But until then, we already have the standard Bayer Assay that puts us on pins and needles, pardon the pun. PSA no matter how fine, will not ease that anxiety we feel and the more fine the more likely it can exacerbate that anxiety.

We need a prostate cancer specific test that differentiates between indolent and aggressive disease...

And that's my <0.1 cents worth...(stealing from Mike in a less sensitive manner)

Tony

One question I have is a quality control type question. How well do the test results repeat themselves? Lets say you have one vial of blood and repeat the test several times using several samples of blood from that one vial. How much do the test results vary from sample to sample? (Assuming that the PSA is evenly distributed throughout the blood in the vial.)

Chris
I do believe that most labs do the test at what you are calling the "hyper-sensitive" level. The terms ultra sensitive and hyper sensitive are interchangeable. The original standard test gave a result to 1 decimal place. Any equipment that can only detect PSA at that level would have to be positively decrepit. Generation 2 tests gave a result of 2 decimal places . That equipment came on to the market in the late 90s and had a lower detection limit of 0.03 so if PSA was not detected the result would be reported as less than 0.03. Generation 3 equipment delivers a result to 3 decimal places. This equipment has a lower detection limit of 0.003. But at this very low level there is much room for error in the results and inaccuracy at 20% or more would be common. For this reason many labs who use hyper/ultra sensitive tests will simply report the result as less than 0.01. Any report that says <0.01 must have been done on "hyper-sensitive" equipment.
Other labs even though they use this "hyper-sensitive" equipment may have a protocol of simply reporting an undetectable result as <.1
Then again some labs may run the test as if they are looking at the general population (where anything at the .1 level is good) rather than those who have been treated for PCa. It is for this reason I make sure that my doc specifies "ultra sensitive PSA ----- progress post prostatectomy"
Bill

I tend to disagree with most posters in this thread a little regarding the value of the ultrasensitive testing. I believe it is generally acknowledged that if BCR is occuring then the sooner salvage therapy is begun the greater the chances of that additional therapy doing what it should. If you have had test results consistently coming in, say, six monthly for a few years at <0.01 and then it begins to rise slowly rise at ultrsensitive levels, that would be enough for me to accept that BCR is occurring and put a plan in place without regard for it reaching some arbitrary level of 0.2 or 0.4
However often with nerve saving surgery PSA may never reach these low levels as benign prostate tissue may well be left atached to the spared nerves. This may well produce trace amounts of PSA which will compromise the value of using the ultrasensitive testing as an indicator of what is going on.
A bit of reading here on the value of ultrasensitive testing:

www.prostate-cancer.org/pcricms/node/121

Bill

Greetings and salutations David,
What I am getting at here is that any test that gives a result of <0.01 must of necessity have been done on what you are referring to as "Hypersensitive". The lower detection limit of what you are calling "ultrasensitive" is 0.03 on some assays or 0.04 on other brands. That is why you often see reports that state <0.03 or <0.04. The assay result in those cases was below the detection limits of that particular 2nd Gen equipment so no PSA could be detected. To get a test report that says <0.01, the actual test result had to have been from 0.003 (the lowest detection limit of the 3rd generation tests) up to .009. Very few labs report the actual figure at such small amounts although I have seen very rarely a result that says <0.003). Because the microscopic amounts detected can be variable at that level and can be error prone they usually just say "less than 0.01". The link I posted describes how very few men with undetectable PSA i.e. <0.01 for a couple of years will suffer BCR, even the higher Gleasons (I think this is what is in the back of Chris' mind). And of the few that relapse from a nadir of <0.01 signs of that relapse can be seen and tracked consistently at very sensitive levels resulting in a clear sign of BCR up to two years earlier than the standard test. As I said this does not necessarily apply to those who probably because of nerve sparing and the possibility of attached benign tissue would not get down to <0.01. And of course it does not apply at all to those who had treatment other than surgery.
Bill