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Is <.1 an ultra sensitive test?

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Posted 8/18/2019 8:58 PM (GMT -5)
The nurse told me over the phone my psa is <.01. I asked here FIVE times.....

“Are you sure it’s a less than sign with a point and then a zero and then a one? Are you SURE it doesn’t say a less than sign with a point and then a one with no zero between the point and the one?”

“Yes. I am sure. The paper reads a less than sign and then a point with a zero between the point and a one.”

“I find that hard to believe. Please read to me exactly what it says very, very slowly.”

“It has a less then sign and then a point and then a zero and then a one”.

“Ok. Thank you.l


Got the lab work in the mail today. It says “<.1”.

I do not believe this test was sent to the same Labcorp Lab as the others were. (And I asked them about that as well. They assured me it was). Either that, or...

My doc changed the type of test he ordered because it’s cheaper and it’s also, in his mind, doing me a favor with the best of intentions by misleading me.
Posted 8/18/2019 9:14 PM (GMT -5)
I've had a few in the past that had to be done over because the lab order wasn't coded right. The magic words seem to be " post-prostatectomy PSA test" if there isn't a specific code for the ultrasensitive test in the system.

I'm having monthly tests at my local hospital at request of Dana Farber. I asked the DF nurse practitioner to write that on the bottom of the lab order she gave me to set up the monthly tests and I am getting results to two decimals.
Jim
Posted 8/19/2019 1:02 AM (GMT -5)
My uPSA costs $22.00 if I was paying cash. Found a lab that only does uPSA.
Posted 8/19/2019 4:43 AM (GMT -5)
No, IT, it is the standard test. But you knew that already.
Posted 8/19/2019 7:12 AM (GMT -5)
IT, just ask the Dr's office to find out if the lab still has the blood sample. If they do, tell him to reorder the test with the test code 140731, (assuming its Labcorp).

If not then you'll obviously have to do a new blood draw, unless you want to leave well enough alone and wait until the next cycle (not a bad idea if you can bring yourself to do it). Nurse needs to learn how to read.
Posted 8/19/2019 10:14 AM (GMT -5)
Thanks men.

I called the office and told the receptionist to order another psa test with the same sample (if the lab still has it).

"The test ordered must be coded as 140731. If it's not coded in the system, it must be a "post-prostatectomy PSA test".

She said she would pass it along to the nurse.

@Halbert. Thank you Halbert. But, seriously, you give me too much credit. I did not know it. I can see, however, how it would be difficult to believe that lol. (It can be difficult to know how to take me.) Let me rephrase....I "kind of thought that"... but wasn't sure enough to go up against my doctor without asking here first.

@oldbeak....I may do that at some point. But now that I have the code, I can tell my doc what I want lol

@ Jim.....not a bad idea. just have 'em put in my chart what kind of test to run. that may help things.


The nurse just called back while typing this. She acknowledged the test wasn't the right test.

@ Prato thank you
Posted 8/23/2019 7:59 PM (GMT -5)
Just to be on the safe side next time, double check that it has uPSA listed if you are using LabCorp - my doc/RALP surgeon proclaimed they "are the best" on more than one occasion.
Posted 8/24/2019 1:34 AM (GMT -5)

GG1273 said...
Just to be on the safe side next time, double check that it has uPSA listed if you are using LabCorp - my doc/RALP surgeon proclaimed they "are the best" on more than one occasion.

The wrong test was ordered. They had me come back to redo. .031

It said just that on the lab report GG.

Thanks a lot.

It looks like you’re through with treatment. Appears they got it. Good luck to you! 👍
Posted 8/24/2019 9:10 AM (GMT -5)
FWIW, whenever I sit down with the phlebotomist, I ask him/her to please confirm they are doing the ultrasensitive PSA before they stick the needle in my arm. Probably a goid practice for all of us.

IT, your PSA has been very stable for a long time now (knock wood), I bet you are done, except for testing out of an abundance of caution
Posted 8/24/2019 10:04 AM (GMT -5)
I like their policy at Mayo they don't do ultrasensitive tests they say its unnecessary.

Larry
Posted 8/24/2019 11:31 AM (GMT -5)
Sky, I don't agree with you about Mayo's policy on ultrasensitive. When I had an ultrasensitive PSA done at home (but sent to Mayo Reference Lab) in June last year it was <0.01. I saw a doctor at Mayo in September and they did the standard PSA which was <0.1 but when I had the ultrasensitive test done in December at home it was 0.11 . If I had had the ultrasensitive done in September it might have been 0.04 for all I know and I would have been alerted to recurrence. This time it didn't matter for me because I chose to wait and get another PET scan to see if I had just one or a few mets that could be radiated. As it turned out I did have only one detected. I'm hoping that is the last one.

My plan going forward is to stay on ADT for 18-20 months then have a holiday. I will have the standard PSA done while I am on ADT but once I go off I will change to ultrasensitive. If ultrasensitive shows a significant rise as defined by three consecutive increases with that last being over 0.1 I will go back on ADT. I might even agree to go back on ADT once the PSA is over 0.06 . My MO wants me to stay on ADT indefinitely but I don't want to, at least not with this first recurrence. The ultrasensitive gives me a warning months earlier than standard PSA. Since at least with this recurrence the doubling time was 6 weeks (a very bad number) I want to know sooner rather than later.
Posted 8/24/2019 12:20 PM (GMT -5)
Argent, I know a lot of guys like the ultra, and that's fine I believe it gives some of the guys more anxiety, for me I don't even think about my psa check cause it will be what it is and then I will deal with it if need be. I know I sure won't continue ADT after October if I don't need to., The darn side effects have sucked the last 4 or 5 months!!!! Even my wife is getting tired of them even tho we both know it's worked so far!! JMHO

Larry
Posted 8/24/2019 2:22 PM (GMT -5)
Seems to me you are both right. Ultra sensitive gives guys a heads up sooner, if there may be BCR after primary treatment. And that seems especially important, at least to me, in light of the recent studies showing that earlier SRT is better. At the same time, yeah, it causes a lot of anxiety, and in many cases ultra sensitive decimal type movements don’t mean anything.

So pick your poison.
After SRT though, I think ultra sensitive isn’t necessary because most MO’s won’t put you back on ADT when your PSA is <.1 anyway.
Posted 8/24/2019 3:39 PM (GMT -5)
We're all different. I would have anxiety if I didn't have access to ultra-sensitive results. I've had ultra-sensitive testing through nearly all of my 17 years of treatment other than a couple of years after surgery - and that was when we were told not to worry about SRT before a PSA of 0.2 - which is no longer accepted as soon enough by many. After SRT it was reassuring to see those 0.00s coming in every quarter for a few years. And when the number finally started to creep up I wanted to track the rate of increase, which stayed low for a couple of years and then accelerated. Now that I'm on break from ADT, I'm glad that I get monthly tests as part of a trial, rather than quarterly. I want to track the amount and also the rate of increase of both PSA and T. Last month I had a tiny uptick in PSA from .02 (the lower limit of the test) to .03. It doesn't worry me because the numbers are so small it is still essentially undetectable. But in months ahead as PSA returns I will want to know both the amount and the rate of increase - in part so I can begin to guesstimate when I may have to start the next round, and in part just out of curiosity.
Jim
Posted 8/24/2019 5:01 PM (GMT -5)
IMHO, an ultra-sensitive test is not necessary for normal PSA testing or testing after radiation treatment. Post RP before SRT seems to make the most sense if you don’t mind the anxiety associated with it that I have seen here a few times here with bogus results and small variances. Since I had ART, I am with Sky that if I exceed 0.10 some day then the next chapter begins, not a day sooner.
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