Well, it just happened to me.

We've had some discussions in threads here recently about guys who had been pulling down <0.1 PSA results from Quest Diagnostics suddenly now getting 0.1 instead.

So this morning I get the email from QD (from their MyQuest Patient Portal app) telling me that the result of my last week's PSA test (now annual for me) was 0.1 (without the "less than" sign).

This after three years, since the end of my IMRT in June 2012, of <0.1 PSA results (all testing done at QD).

Having followed the said discussions here about others experiencing this, I was at least somewhat prepared for this revolting development, and was not particularly shocked, but still concerned. I will definitely ask my uro's opinion on all this when I see him for my annual checkup next week.

In fact, when the earlier discussions here were going on, I had actually taken some time to do some websearching on this issue myself, very possibly with it subconsciously in the back of my mind, knowing that my own PSA test was coming up, and it could happen to me. Which it did.

But I'm afraid I found after doing what I believe was a pretty thorough search, very little addressing this particular point. But I did note a theory that was consistent on a number of PCa-related sites, that QD operates testing machines that are wired differently. Some report the undetectability of a sample as <0.1, while the other machines, working on the same sample, would report it as 0.1. So perhaps it's just a matter of luck of the draw, which kind of machine one gets. Maybe the machines are from different generations, or something. Speculation, but it certainly seems possible.

Well, I have decided that I will now attempt what will likely turn out to be a futile effort. I am going to go to QD's website, locate some kind of customer service phone number, give them a call, and see if I can learn anything from the people who should actually know something about this. But I'm afraid that all that is going to happen is that, if I ever do get past the automated response system and reach a real human being, all he or she will say is "we are not authorized to discuss testing procedures over the phone," etc. Well, I'll give it a shot anyway, and let you all know if it actually happens that I learn something from this effort.

I guess the main reason I wanted to post about this was to confirm that there does indeed appear to be something going on here with QD, and that may well turn out to be testing machines that get a little quirky when it comes to reporting people's PSA test results.

Of course there may be more coming out about this in the future, so I guess the byword here is stay tuned.

But for now I guess I will have to update the final line of my signature below, from "<0.1" to "0.1 or less." Oh well …

81GyGuy
Seems odd that if ur gl6 you'd have recurrence. The thing is you don't know if all ur PCa is gl 6 unless the prostate is removed. I was never a fan of ultrasensitive PSA testing but have become one. If I were you I'd have my uro write scripts for ultrasensitive scripts going forward.
Bob

I've had the same experience since my uro's practice switched to Quest. I always get an ultra sensitive test--to two decimal places. Due to the uro's office staff checking the wrong box on the lab form, Quest did only a standard test to just one decimal place. They reported the result as 0.1 without a <. My uro had them retest with the ultra sensitive test I was meant to have and the result came back as 0.05. Even though I did not originally get the test I expected, I can't understand how Quest could have reported that result as 0.1 rather than as <0.1.

Quest doesn't have an "ultrasensitive" test like LabCorp. Their sensitive test (two decimal places, down to 0.02) is their "post-prostatectomy" test. Maybe your doc didn't ask for that one so you got the regular screen instead.

I understand your frustration with the lab, but either way there is nothing to worry about. You have a prostate (and a history of prostatitis), so you will always have some residual PSA. Also, maybe your T levels are returning to more normal levels and stimulating a small amount of BPH. I'm frankly surprised that it has been undetectable at all. This is exactly why recurrence is defined as nadir+2.

- Allen

81:

If one machine does one thing and the other another, or if QD reports the same result differently based on the price of tea in China, this is TOTALLY UNACCEPTABLE.
As a sidebet, I predict they will admit to neither of the above.

Mel

The whole point of the discussion is that Quest, or whomever, needs to have consistent reporting guidelines independent of the instrument or lab location. It's called QA/QC reporting protocols. If they have them (I'm sure they do) and they're not following them, that's a problem. If they don't have them, that's a bigger problem. If they are reporting unverified, non QA/QC compliant data, then this calls into question EVERY data point they report. EVERY ONE.

81gygy, please keep us posted about what they say. My guess is that they'll tell you it's an isolated case of mis-reporting and let it go at that. Your experience, and our good friend Pratoman's experience not long ago suggest structural problems at Quest that go deep. My guess is that the "business" people (the beancounters) are in charge there, not the "lab" people. Getting it right is less important than getting the numbers out.

Pratoman -

Thank you very much for your insights and very practical suggestions. Yes, I did read your earlier posts about your experiences with QD, and I think the comments you have made about QD get right to the heart of the matter.

I do appreciate your suggested "next steps" on how to proceed here, and I am indeed keeping them in mind. It's looking like you are the one here with the best experience at dealing with this issue, you have already lined up contact(s) with QD, and the rest of us will be well served to follow your advice in this matter.

For now, I'll just wait and see if I do get a reply to the question that I submitted to their website, and if I do get one, whether it's a meaningful reply or not. But if I do see the need to pursue this further, I will be using your good advice as guide.

Thanks!

I think the point is that there are unexpected inconsistencies.
Jackh-- the inclusion or exclusion of the < sign is kind of a big deal.

Perhaps it is just a statistical anamoly, within the tolerance range.
Yet, I don't see these issues with any other lab, based on HW postings.

I predict nobody will get any clear answers, especially if there is a systematic problem with Quest.

Yes, it is a business decision. But don't forget there might well be some legal liability issues, too. Maybe someone more knowledgeable about legal issues can weigh in.


Mel

I never knew you could just walk in and get a PSA test without a prescription. If thats the case , i stand corrected. Of course that is assuming the person can afford whatever the lav will charge without insurance

As far as the difference between <.1 and .1, once again, the mindset of the person is being discounted in importance. I think that
1. its the difference between undetectable and detectable
2. its an important difference if its enough to concern the person being tested
3. if in fact it is an inconistency in QD systems and processes and results, then its a very big deal - for ALL of us.

Logos makes a good point, maybe it doesnt matter considering 81Gguy had radiation, and didnt have his prostate out. At the same time, its strange that for a considerable period all tests came back undetectale until now.

@81GyGuy, I initially also sent an email to Quest through their Quest360 website. It took them over a week to respond, by which time i had already spoken to Patient Advocacy and the Executive who called me, and my test results had been revised. They did not even know that.
So if you do decide to wait till you hear back, be patient. And btw, if this isnt bothering you to the point where you are really nervous about it (probably shouldn't at this low leve) then waiting is probably the right thing to do.