Psa 0.04 4 and a half y after RP

No, you don't need to worry. That's just test noise.

and at that low level of PSA things can get bouncy.

The only time you can start worrying is if you start seeing consistent increases above .05. You'd really need to see three increases before being concerned.

Now you just need to relax and wait for the next test. And waiting is always the hardest part.

Andrew

Thank you all for the reply.
Having seen his report now it wrote PSA 0.044, which is aaaalmost close to 0.045 or 0.05 for my thinking...
I'm really emotional at the moment. Thought this would be behind us, and have a peaceful Christmas and now this (although at different laboratory)...
I really, really hope at his regular lab next month (I'll tell him to go sooner than next summer when he has an apointment) the PSA comes back to 0.02 as did all those years. If it doesn't that wouldn't be good...
If the worst happens (PSA starts to rise every single time when checked), could the radiotherapy kill it? Or is it just buying my dad's time?

Peace be with you.

Thank you all so much for the replies.
I'm a little relieved by now...Its funny how few positive news impact a person.
Wish you all the very best.

Internship41 said...
Thank you all for the reply.
.....Or is it just buying my dad's time?

Frankly, isn't that we are all doing in this life, PCa or not?

Relax, enjoy the holidays, and peace be with you as well.

Congratulations. I hope it stays that way too!

jmadrid said...
Your father's psa always fluctuate in the range 0.02-0.05, which is not bad at all. If possible, I would check the numbers that other people going to the same lab usually get. Or just listen what your doctor (who probably has this information) thinks. Some labs, particularly outside the US, do not write a "minus something" to indicate that the number is below the instrumental precision, just report the raw value given by the instrument. And many test are not specifically ultrasensitive for after surgery, they are made with the same psa calibration used for diagnosis. In these cases, 0.02 and 0.05 practically mean the same. Of course, you are always psychologically reassured and kind of rewarded when you see a decrease, but you do not have to worry much when the new number is a bit up as far it is within the range it has been before and you do not see a clear trend upwards.

I've checked into this since the last time you posted it. My LabCorp Ultrasensitive, Post surgical report lists as it's "reference interval" as ".000 - 4.000". (It will flag at 4.01) There is no "<" sign used, but it is still calibrated as ultra-sensitive.

The lab I used before listed it's reference interval as "<3.5". (It flags at 3.5) It also was calibrated for ultra-sensitive, post-operative testing.

So, at least with my research, I'm comfortable in knowing that an ultra-sensitive test can use a "<" or not.

Any report should say what kind of report it is. If it is ultra sensitive, it should say so. If it is not an ultra sensitive report, it will not say ultra sensitive on it.

Overseas may be a very different thing.


Internship.....

Your father is in the same boat as many other men. There may be some rogue G6 cells left. It doesn't mean your father is not cured. As of now, he is. But that's no different from anyone else who's ever had cancer. "As of now..." is pretty much what we all have.

One thing I will say, at least the way I look at my own PSA readings anyway, is that, "If or when it goes up, you'll know it".

It is disconcerting when the pathology isn't perfect and we get some readings higher than others. It's stressful and anxiety producing. However, the only medical recourse to that is to have more treatment that you possibly may not need. It's kind of like having a tooth pulled when nothing is wrong with it....just so they'll never be anything wrong with it. That's not something I can do to myself.

The bottom line is...."Relax". Your father is going to be around for many years to come.

Internship41 said...
Thank you all for the reply.
Having seen his report now it wrote PSA 0.044, which is aaaalmost close to 0.045 or 0.05 for my thinking...
I'm really emotional at the moment. Thought this would be behind us, and have a peaceful Christmas and now this (although at different laboratory)...
I really, really hope at his regular lab next month (I'll tell him to go sooner than next summer when he has an apointment) the PSA comes back to 0.02 as did all those years. If it doesn't that wouldn't be good...
If the worst happens (PSA starts to rise every single time when checked), could the radiotherapy kill it? Or is it just buying my dad's time?

Peace be with you.

I hope you can stop worrying. You can always worry later. Stop and think for a minute: when you first came here early 18, you were worried because "Psa has been for the first one or two years below 0.02, after that 0.02, then in Autumn 2017 0.04. three months after that 0.02, then two weeks ago 0.04."

So, after 4.5 years, in the fall/autumn of 17, he was at .04. Now a bit over a year and a half later, he has skyrocketed up to .044.

IOW, basically no change in well over a year. This is not something to be worried about, not yet. It is just something to keep an eye on. This rate of growth- if it is even cancer- is so far at a snails pace. Which could well indicate that if there is actually any cancer in there, it is not aggressive and is likely the kind that will never kill him. There are PC cancers that will just never kill you, not before something else gets you first. (heart attack/stroke/other cancers/ a fall while mountain climbing/ etc )

If and when he doubles from here, and maybe keeps going up at a steady rate a bit every few months, then maybe consider some RT, which will probably get him right back down to <.02. Or, you maybe will have to throw some androgen blockade at it. But right now, all of that is still a big IF. And IF he ever has a BCR, that is still a LONG ways from ever metastasizing and actually dying from PC, especially if he gets some more treatment once he is obviously about to BCR, or shortly after a BCR.

Here is a tool, a nomogram from a famous hospital, that you might want to play with.
https://www.mskcc.org/nomograms/prostate/post_op
I plugged in a pre op PSA of 9(just guessing), and 68 months since surgery, and Gleason 4+3, negative margins and SV and nodes. (go in and correct if needed). His odds are superb. He has a 94% chance of still being "cancer free" (meaning no BCR, not yet a high enough PSA to call it a recurrence) at 7 years, and 82% at 10 years. His odds of PC NOT having killed him at 15 years is 98%. So even if he was still a < .01 now, his odds could only get 2% better(100%, and I doubt it would do that well)

If only his, and maybe even your, odds of not having a heart attack or stroke were that good! I would not waste any more chance at worry free happiness on his PC status until and increase worthy of concern actually shows up. Once and if that ever happens, you will have plenty of time to worry then. But for the moment, the odds are 94% that a BCR ( recurrence) will not happen for at least 2 more years, or 82% of NOT happening even at the 10 year mark. True, you might beat those odds in a bad way, but probably not.