Posted 9/22/2013 1:55 PM (GMT -5)
Hi An38, - Is there some particular reason that Paul is having a Hyper- or Ultra-sensitive PSA assay used in his PSA monitoring? Unless it can add USEFUL information to your care, what does it really matter where your often insignificant PSA readings are bouncing around ?
In ROUTINE post-treatment monitoring, most leading U.S. Cancer centers, such as Mayo Clinic and Johns Hopkins do NOT routinely use these super-sensitive tests, since they usually cause far more NEEDLESS worry for the patient, than it adds any useful benefit to the monitoring results. This is because the greater sensitivity of the assay also creates the SUBSTANTIALLY greater possibility for non-biological variation in such exceptionally sensitive readings, very many of which do not have any real clinical significance.
Rather, you should rejoice in the fact that Paul has only pathologic (as opposed to clinical) T2 disease, which is the lowest pathologic tumor grade that can be assigned, although the "c" does indicate that it was found in both lobes. Further, his post-surgical PSA history adequately displays a minutely VARIABLE, up and down, PSA over a long enough time, that, so far, does NOT establish any consistently rising PSA that is usually present with recurrence.
There is a place for the use of Hypersensitive assays in individual situations, particularly in advanced disease where that information may be of value in fine tuning the treatment regimen. In cases of low or moderate risk disease, it is HIGHLY unlikely that any treatment changes are going to occur prior to confirming a recurrence and that has traditionally been at 0.2 ng/ml, with 0.1 becoming the warning flag. SOME institutions even wait until 0.4 ng/ml before any secondary treatment is prescribed, because there is documentation of men who reach very low levels in PSA results after treatment, but whose readings then plateau rather than continue to rise.
Since it is extremely rare for low or intermediate risk patients to have secondary treatment instituted prior to a confirmed 0.2 ng/ml PSA reading, tracking PSA readings below 0.1 ng/ml provide very little, IF ANY, prognostic information of treatment value for the vast majority of such patients.
As a PERSONAL example, I have had consistantly “undetectable” PSA readings of LESS THAN 0.1 ng/ml (<0.1) for 15 consecutive YEARS and have never considered having a more sensitive assay employed. So although I do not know at what level my sub one-tenth of a nanogran per millelitre reading exists, realistically I do not care, because no corrective action would even be contemplated prior to confirmation that my total PSA exceeds that important threshold. In the meantime, I have enjoyed many years free of the PSA anxiety that negatively impacts so many men, some of whom MAY have lower PSA levels present, that are lower than mine. My PSA levels MAY have actually varied anywhere between 0.001 to 0.09 ng/ml without my knowledge but, pragmatically, why should I care?
There is nothing WRONG with having a more sensitive PSA test if you wish, PROVIDED you take the responsibility to thoroughly understand the nuances of PSA testing and the relative significance of any PSA results as they pertain to YOUR personal situation. Far too often, men having Hypersensitive PSA tests for ROUTINE post-treatment monitoring are the very ones in whom slight variations in results cause undue concern and needlessly heightened PSA anxiety. Your glass is more than half full, so imbibe the encouraging results rather than focusing on the likely meaningless variations. Be vigilant but keep results in perspective with their most likely statistical significance.
But listen to what the recognized experts have to say, by reading the following article from a Johns Hopkins publication that specifically addresses the subject:
Good luck! - John@newPCa.org (aka) az4peaks
ARTICLE:
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 and physicians 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."