Has anyone had post-surgery uPSA results on the Labcorp test of <0.006 and eventually had BCR?

Hello. I’m curious to know how many folks here had an RP, then have taken the Labcorp uPSA after surgery and gotten back an undetectable result of <0.006 but eventually had a biochemical recurrence. If so, how long did it take for you to recur after your last <0.006 reading? What were your PSA trends along the way. Thanks for any info.

@hosed... welcome to the forum. I assume you are experiencing BCR after surgery?

My PSA became detectable at Quest at .02, two years post surgery. I switched to labcorp, and watched my PSA slowly rise to .08 a year later, at which time I pulled the trigger on SRT + ADT.

I hope that answers your question

Suggestion: go into your profile, and enter an auto signature which will appear at the end of your posts. That way when you ask a question, members will know your history and not have to look back at your previous posts. Just enter your stats, i.e. Gleason score, treatment, etc. You can look at my signature or others, as a guide.

Thanks for the responses. I will indeed update my bio info at some point. I’m 14mos post-RP. Gleason 4+3. Negative frozen sections but <2mm positive margin. Organ confined. Had a whopper pre-surgery PSA of 37 on my first PSA test ever so I feel lucky there was no (evident spread). Basically I’m just a guy that’s in an okay place now but know the MSK nomograms show 65% chance of BCR in the next 10 years, so I’m interested in people’s experiences if they recurred from a super low uPSA like mine.

The reason I asked the question is that I’ve seen many studies talking about much lower recurrence odds (at least for the first few years) if you are <0.01 on your first couple post-surgery PSAs. I think there’s value in these lower testing thresholds, even if it is against the consensus. I see a lot of guys say “I was <0.02 on all my tests and then recurred” or “I was <0.05 and then it came back” but I see very few Labcorp <0.006 that have had BCR. I’m sure there are more. As for someone like @Pratoman, your case does interest me but we still can’t say if you were maybe 0.018 or something, as you said. @Bobbiesan’s case is interesting to me because you obviously were <0.006 at some point and then have recurred, or are on your way there, albeit very slowly which is what one would hope.

Thanks for the responses thus far.

Hosed66,

Thanks for explaining your situation. I have gathered some information that should help you.

My RALP was in 04/2012.

Following were some of my earliest uPSA readings, when both my uro and I (separately, more frequently) were tracking my scores closely. Note the (P) was my personal test (all LabCorp) and the (U) were at a university med center (labs unknown):

05/12/12 (P) < .010
06/17/12 (P) < .010
08/12/12 (P) < .010
11/06/12 (P) < .006
12/11/12 (P) < .006
01/07/13 (U) < .050
02/12/13 (P) < .006
04/08/13 (U) < .050
05/14/13 (P) < .006
07/11/13 (P) < .015

After that last test, I have never had a LabCorp uPSA test show a lower limit other than "< .015" ; the guys on this board and I discussed this apparent Labcorp switchover -- you can read about it here:

https://www.healingwell.com/community/default.aspx?f=35&m=2596661

It seems some guys are still getting access to tests that have ultra low limits, but I am kinda in the boondocks, so don't know about that.

Sometime between 2013 and 2017, my uPSA left the .006 level and eventually went high enough to surpass .015, but no telling exactly what that slope was.

Since then, my uPSA history has looked like this:

https://imgur.com/a/praguxr

Btw, I have a buddy that is in my same boat -- we put our uPSA histories above one another, and you might almost think we were medical twins. Slow rise over time. Lots of wasted testing, right? Yet, I would rather have my data and not need it, than need it and not have it. Following cases in point make me watch for my PCa to "make a break for it and run...":

https://pmc.ncbi.nlm.nih.gov/articles/pmc6818640/#:~:text=biochemical%20recurrence%20(bcr)%2c%20i.e.,is%20usually%20a%20few%20years.


I would surely like to know what my medical situation is "under the hood". My guess is my 3 mm positive margin is growing. But since Epstein (JHU) rated my +margin at 3+3=6, I am disinclined to seek secondary treatment unless I start feeling that I will get clinical PCa recurrence symptoms before I die of something else. Age 75 now...you know. Each guy has his "YMMV".

May I suggest you get your path slides read again (second pathology) with attention to your <2 mm positive margin? If you wait too many years, the slides' tissue may degrade such that a 2nd path is useless. It will be important info to keep handy if you head towards recurrence. Hope you don't.

Let me know if more questions.

Regards,
Robert

Hosed - I did a deep dive 10 minute research project into this PSA subject. My quick conclusions based on 5 minutes of searching and 5 minutes of reading were:

1) Did not find that anyone has studied 0.006 and the lowest analysis cutoff studied seems to be <0.01
2) Men with PSA <0.01 appeared to have longer duration to BCR than those >0.01 (at 3 mos or 2 years?)
3) No one knows where the actual break point is but some feel that 0.03 is probably the better value than 0.01
4) Post-op PSA is one factor whereas there are other risk factors from the post-op pathology that contribute to recurrence timing and BCR probability as well.
5) Did not see anything relating to death from PCa and ultra low PSA.

The analysis tends to be for small sample sizes and the usual 5 & 10 periods. I suspect finding appropriate men that have a 10 year history of <0.006 or 0.01 testing is difficult to start with.

The question always comes back to those with poor pathology and other indicators that are considering if and when to start secondary treatment without a significant PSA (0.01) or with a low PSA (0.05). Having a really really low PSA helps guide that decision but most seem to be waiting for much higher PSA values now before considering SRT based on the larger studies.

Hi Hosed and welcome to the Forum!

If it helps, I'm pasting my Labcorp uPSA history below. My post-RP nadir was 0.007, so a tad above this test's lowest detectable level, 0.006. I could reach the official BCR threshold of 0.2 in the coming months.

Labcop uPSA

11-28-17 0.010 (3 months)
02-26-18 0.009
05-30-18 0.007 (nadir)
08-27-18 0.018
09-26-18 0.013 (retest)
11-26-18 0.012
02-25-19 0.015
05-22-19 0.015
08-28-19 0.016 (2 yr.)
12-18-19 0.015
06-30-20 0.013
12-30-20 0.037
03-31-21 0.020
07-13-21 0.018 (4 yr.)
01-25-22 0.023
07-25-22 0.038 (5 yr)
10-24-22 0.036
02-02-23 0.049
05-04-23 0.054
08-03-23 0.065 (6 yr.)
11-14-23 0.068
02-20-24 0.079
05-21-24 0.094
08-14-24 0.111 (7 yr.)
08-21-24 0.125 (retest)
10-07-24 0.118
10-15-24 0.12 (Duke Labs)
11-07-24 0.123
01-07-25 0.153

I recently consulted with a R.O. at Duke who wanted the Duke-lab PSA check, which corroborated the Labcorp value. My case is rather unusual: the very slow PSA increase over 7.5 years isn't the typical rapid rise seen with high-risk men who experience BCR. Although I am high-risk--G9 (4+5)--I was pT2 after surgery, with a (likely) early diagnosis, a downgrading of my biopsy G(5+5) to a G(4+5), a post-RP PSA nadir <0.01, no positive nodes among the 16 removed, no adverse findings, a fairly low pre-surgery PSA, and a low-risk Decipher score. For these reasons, my uro and the R.O. advised me to hold off salvage treatment for now.

We may end up "blindly" zapping the prostate fossa if I climb but am still at a PSA too low for a PSMA-PET scan or we may just wait until I have a better chance at a scan revealing something. Currently I'm researching my results in the Decipher GRID report (a free report you can request with your Decipher test) to help with decision-making regarding SRT. I've opted for monthly uPSA checks. Unless my PSA increase speeds up, the plan is to meet with my uro every 3 months and my R.O. every 6 to re-evaluate.

As you may know, many men who experience BCR do not go on to clinical recurrence (detectable lesions); however, many still want to improve their chances by getting salvage treatment.
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Could you kindly create a signature file with your history and post-RP path findings? It will help Forum members hone their replies to your posts.

Djin

@NorCol, thanks for that info. I did go back and look at your posts. They were helpful. Good luck to you.