0.03 ng/ml best indicator of biochemical recurrence (Johns Hopkins)

Thanks for the post. I was 6 years out post surgery and my PSA went from <.01 in my seventh year to .02 and then .03. I pulled the trigger and had SRT this year. Although my PSA by all accounts was stable but increasing, being a Gleason 8, I wanted to start early. I know it my be controversial but it was my decision and doctors concurred.

That sure is a low number.

My Uro suggested RT immediately after surgery when EPE and + margins were detected.

As it happens my first uPSA post surgery was .03. Six weeks later it was .07.

He then added HT to the treatment mix.

In spite of some adverse SE's I am very glad he took an agressive attitude to my treatment.

Chas

Jeff,

Actually for a "high risk" guy like yourself, the numbers are even more compelling. The JH study included all men who had "undetectable" (<0.1) PSA following RP. In the Kang et al. study (review below), they only looked at "high risk" men, like yourself. For this purpose, they defined "high risk" as either T3/4 or positive surgical margins. In those men, a PSA of ≥0.03 at any time predicted with nearly perfect (98%) accuracy that the PSA would later progress to ≥0.2. No recurrences were missed using that cutoff.

When should the patient and doctor consider salvage radiation therapy?

- Allen

Allen,
Good information. I am a T3a and will be anxiously awaiting my uPSA in December, approximately 22 months
post op.
Appreciate it.
Jess

Very interesting article.

There are variations in ultra sensitive PSA tests when different assays are used. So my husband had two laboratories test his PSA, one came up with a result of 0.03 and the other with a result of 0.01 for samples taken on a single morning. This is back in early 2011. The two laboratories showed similar fluctuations up and down but from a different base. My concern is that with this article and with only access to a 0.03 result people in our position would have gone to SRT.

What it also does not clearly explain for me is what the right course of action is for favourable pathology post RP. (3+4, T2, clear margins, cancer volume <5%) Paul is five years post RP. We only go to the one laboratory now - the one that originally baselined at 0.01 and Paul's PSA is now 0.02 (and has been for the last two years, although it was back down to 0.01 in February). If it ever goes to 0.03 do we need to consider SRT?

It seems that what is lacking in this approach is an additional digit on the ultra sensitive PSA reading and more clarity and standardisation on assays and calibration of equipment.

Thoughts?

Regards,
An

Forgive my ignorance but is their a standard deviation with PSA testing equipment?

Thanks Allen.

I have always thought that the ultra sensitive test was the way to go and this article supports that view. I remember that not long ago on this forum that people who were seeing upward movement in their PSAs below 0.1 and were focussed on these changes were almost characterised here as hypochondriacs with the common refrain being "a zero is a zero is a zero", a zero of course being anything under 0.1.

An

NB: Allen, I could not find that link for the T2 patients. Could you please post it?

Somebody said...
Johns Hopkins examined its own database and found the same thing.The study by Sokoll et al. looked at the records of 754 men treated with surgery at Johns Hopkins between 1993 and 2008 whose first post-surgery PSA, taken at about 3 months, was “undetectable” (< 0.1 ng/ml). They reanalyzed the stored serum samples using an ultrasensitive PSA assay that could detect values of 0.01 ng/ml or higher. Each man was tracked until biochemical recurrence (BCR) — defined as a PSA level ≥ 0.2 ng/ml — or for at least 5 years if there was no biochemical recurrence (median of 11 years).

Among men whose first uPSA was ≥ 0.01 ng/ml, about half eventually had BCR.
57 percent were BCR-free at 5 years; 49 percent at 11 years.
Mean BCR-free survival: 10 years
Among men whose first uPSA was < 0.01 ng/ml, 87 percent remained BCR-free.
92 percent were BCR-free at 5 years; 86 percent at 11 years.
Mean BCR-free survival: 15 years
Among men whose first uPSA was ≥ 0.03 ng/ml, 77 percent eventually had BCR.
27 percent were BCR-free at 5 years; 22 percent at 11 years.
Mean BCR-free survival: 5.5 years
Among men whose first uPSA was < 0.03 ng/ml, 85 percent remained BCR-free.
91 percent were BCR-free at 5 years; 84 percent at 11 years.
Mean BCR-free survival: 15 years

Just to be uClear(ultra clear), what is the definition of first uPSA? Is this the first post surgery PSA, on average taken at about 3 months post op? Which was originally <.1, but was later reanalyzed with uPSA techniques? Thanks in advance.

JNF,

No, it doesn't apply to you (or me) - only to men who've had RP. For us, BCR is defined as a confirmed nadir+2 (Phoenix definition), so uPSA would be like measuring the length of a city block in millimeters. Because we have intact prostates, we can get PSA fluctuations from other sources aside from cancer and small changes would drive us both, or at least me, crazy. They changed it from an earlier definition (the "ASTRO" definition) which was 3 consecutive rises, precisely because uPSA tests could easily rise like that for us radiation guys without any underlying cancer causing it.

- Allen

Billybob,
As it says, "...whose first post-surgery PSA, taken at about 3 months, was “undetectable” (< 0.1 ng/ml). They reanalyzed the stored serum samples using an ultrasensitive PSA assay that could detect values of 0.01 ng/ml or higher. "

I'm not clear about what is unclear to you, as it seems clear to me.

-Allen

Just completed 37 SRT treatments, my PSA 3 1/2 yrs after Robotic, went from .17 to a year later at 1.0.
pre op PSA 4.8
3+4=7 after op
t2c
prostate 6%
1 lymph node micro mast
Bone scan, MRI, CAT scan all clear before SRT
no margins
All nodes were normal
DR believes some tissue with cells left in prostate bed
Blood test Oct 12th