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PSA Reading - What to Believe?!?!?

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Posted 1/19/2021 11:53 AM (GMT -5)
I have read often that LabCorp is not overly finite. In this case, I hope it's true.

Roughly one month ago, my first PSA post-IGRT was done at my Uro's office. It came out 2.4 (done in-house). This past Saturday, my Endo had me do a PSA at the local LabCorp and that came back as 2.6.

Cause for concern???

NJ Fred
Posted 1/19/2021 12:19 PM (GMT -5)
Hi Fred. Others can comment on post-RT PSA trends. I would only note that (1) there is uncertainty in the right-most digit of any test and (2) testing on different equipment -- whether or not the same assay method -- can lead to differences.

Djin
Posted 1/19/2021 12:25 PM (GMT -5)
I assume you recently finished IMRT as treatment, dont see and data or anything in a signature?

I would stay with one lab and use them for future tests, also assume you didnt have ADT.

your PSA will take time to decay and you could go up and down. I am over 2 1/2 yrs and finally got under 1.0,have not had bounces.

Be patient, you are still early in plan,
Posted 1/19/2021 12:27 PM (GMT -5)

DjinTonic said...
Hi Fred. Others can comment on post-RT PSA trends. I would only notes that (1) there is uncertainty in the right-most digit of any test and (2) testing on different equipment -- whether or not the same assay method -- can lead to differences.

Djin

Allow me to expand. It has been a rocky road the past few moths (above and beyond Covid). My kidneys are beat up to stage 3b - - and to say my knees have been knocking is something I confess (without pride - many far, far worse off than me).

Today brought a bit of happiness. Nephrologist saw improvement and I am ecstatic. God works in strange and wonderful ways.

Good time for me to say that I pray for all who post hereon. A swell bunch of brothers who are plagued through no fault of their own. Maybes one day, we will be able to take this board down when a cure is in our hands.

Thanks, Djin - more than words can say.

NJ Fred
Posted 1/19/2021 12:29 PM (GMT -5)

Turboz said...
I assume you recently finished IMRT as treatment, dont see and data or anything in a signature?

I would stay with one lab and use them for future tests, also assume you didnt have ADT.

your PSA will take time to decay and you could go up and down. I am over 2 1/2 yrs and finally got under 1.0,have not had bounces.

Be patient, you are still early in plan,

Correct you are - - no ADT. Completed 45 IGRT (Tomotherapy) sessions on 8/17/20. My PSA going in was 8.7. Gleason was 3+4=7.

Thanks you for your comments, sir.

NJ Fred
Posted 1/19/2021 1:27 PM (GMT -5)
NJ Fred - Radiation scrambles the DNA of the cancer so that cell reproduction is not successful. While it may kill some cells initially, it takes a while for this process to end and stabilize. Your numbers seem to be in line with others that have had RT primary treatment. Just try to relax and let the numbers come in over the next year. When you get a bunch of them, you can look for trends and bounces.

As others have said, just get the results at one lab and save yourself the trouble of trying to figure lab variation out at the same time.
Posted 1/19/2021 2:02 PM (GMT -5)

Mumbo said...
NJ Fred - Radiation scrambles the DNA of the cancer so that cell reproduction is not successful. While it may kill some cells initially, it takes a while for this process to end and stabilize. Your numbers seem to be in line with others that have had RT primary treatment. Just try to relax and let the numbers come in over the next year. When you get a bunch of them, you can look for trends and bounces.

As others have said, just get the results at one lab and save yourself the trouble of trying to figure lab variation out at the same time.

Thanks, Mumbo!

NJ Fred
Posted 1/19/2021 2:48 PM (GMT -5)
Peakin as an analytical chemist who has a general understanding of variability and in addition being on AS monitoring PSA. that difference means nothing. You will need a trend of at least 3pt sometimes more. When i started on this road i actually took readings once a week for six weeks just to understand the variability and found for me it could swing by at least 0.3 or 0.4 pt during a short time period of a little more than a month. Not saying everyone should do this or the above statement applies to eveyone but as djin said be careful about taking the last digit too seriously
Just my crazy 2 cents
Posted 1/19/2021 3:04 PM (GMT -5)

mufjem said...
Peakin as an analytical chemist who has a general understanding of variability and in addition being on AS monitoring PSA. that difference means nothing. You will need a trend of at least 3pt sometimes more. When i started on this road i actually took readings once a week for six weeks just to understand the variability and found for me it could swing by at least 0.3 or 0.4 pt during a short time period of a little more than a month. Not saying everyone should do this or the above statement applies to eveyone but as djin said be careful about taking the last digit too seriously
Just my crazy 2 cents

Your "two cents" is worth a lot to me - thank you!

NJ Fred
Posted 1/19/2021 7:53 PM (GMT -5)

Hello N.J. Fred ----

My trusted oncologist taught me the importance of following trends, and expecting a few fluctuations, after my radiation treatments.

He reminded me that we were tracking data, building PSA history, watching for trends --- but fluctuations were part of "the game" ----

Every fellow I know worries over any uptick they see in PSA levels --- but as months went by, I also experienced downturns in PSA, following radiation - just when I least expected it.

You are on top of this --- you and your medical team are watching things - and you are assessing PSA levels at timely intervals.

My lesson learned? Stay vigilant -- don't cross the bridge until you reach it - trust in your doctor's wisdom - follow-up with timely medical visits - and keep living life to the fullest.

Best news? You are doing ALL of these things, N.J. Fred!

Appreciative of your ongoing thoughts and concern for all of us here!

There's "heart and soul" in all your posts -
CYCLONE ~~~ # Iowa State University
Posted 1/19/2021 8:30 PM (GMT -5)
Fred, at five months post IMRT your PSA is well within the expected range. You have a prostate that’s been toasted but not removed. The cancer dies a slow death and the prostate still gives off PSA along the way. RT can be a bit of a marathon for us RA guys. You can see from my post RT PSA’s that it can be bumpy ride and still very normal. Stay on a routine schedule for testing and watch for trends.
Posted 1/19/2021 10:28 PM (GMT -5)
The standard for recurrence after primary radiation therapy is set by the Phoenix Definition.

If your PSA rises two points above your post-treatment nadir (lowest reading), recurrence can be assumed.

https://pubmed.ncbi.nlm.nih.gov/17968996/
Posted 1/20/2021 9:34 AM (GMT -5)
Good Brothers All,

Spoke with Radiation Oncologist late yesterday. To listen to him was to listen to all of you!

My mind is at ease and my feet back on the ground.

Thanks again and God Bless us - everyone!

NJ Fred
Posted 1/20/2021 10:13 AM (GMT -5)
Fred, reality is that your treatment cut your PSA in half. That is what is expected from successful treatment. Now, your PSA will fluctuate at the decimal point level, but trend downwards for a while--a year or two or longer, until it hits minimum. It's a marathon.

Now, get out the steaks and enjoy!

Peace
Posted 1/20/2021 2:58 PM (GMT -5)
Hi Fred, Just as an aside, I also refrain from supplements (unless under Dr's orders) for about a week prior to getting my uPSA test.
Just got my undetectable back this morning from Monday's blood draw.
Posted 1/29/2021 3:56 PM (GMT -5)
I have my official PSA done by Wake Forest because my Primary Care doc is part of that group. Medicare pays for it. I use Walkin-in lab to have another PSA on the same day with Lab Corp which I pay for ($40).

I like having a comparison. Lab Corp reports in the tenths (0.0), whereas Wake in the hundreds (0.00). In the past 4 years Lab Corp has been exactly the same, but Wake varies more. I have no idea why.
Posted 1/29/2021 5:51 PM (GMT -5)
hrpufnstuf, Labcorp can run the ultrasensitive which will give you a result in the 100ths, i.e. <.014
Posted 1/29/2021 6:33 PM (GMT -5)
Prat, everytime I order a test through Walk-in's website I have the option to use Quest or Lab Corp and I think of your experience with the sorryass Quest lab. You were way to lenient with them in my opinion.
Posted 1/30/2021 12:22 AM (GMT -5)
Ultrasensitive PSA tests are not applicable to men who still have prostates.

Men who have had primary radiation or focal ablation treatment have recurrence threshold as stated in the Phoenix Definition, which is totally independent of what RP guys follow.

For the OP: you now have a nadir of 2.4, it could go lower. Recurrence could be assumed if you later have a reading two points above your nadir, at 4.4.
Posted 1/30/2021 12:27 AM (GMT -5)
The big reference labs run ultra-sensitive, to the thousandths place (0.000) post-treatment PSAs if the physician checks that box on the order. Otherwise, you get the regular PSA. A variation between 2.4 and 2.6 is just noise, i.e., statistical variation.
Posted 2/15/2021 1:47 PM (GMT -5)
GG1273.......I like your advice about stopping all supplements except Dr. emphasized a week before.....makes great logic just in case they could be masking results, which could register even lower. My last two PSA score... but still on Lupron.......0.12 and 0.10 on 2-11. I did not stop supplements either time right up to lab draw. I am going to stop like you did a week before my next PSA in May.
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