PSA test undetectable threshold

User

Posted 17 May 2017 at 23:34

I found that my 2 local hospitals measure psa down to 0.05 and 0.06. Meanwhile on here some people are being given follow on treatment because their psa has climbed to 0.02.

Yet it's also being said that at least one hospital has moved to reading down to 0.1 and that test results fluctuate from the same sample so high sensitivity tests cannot be trusted.

I find it hard to believe that 0.05 is an adequate threshold for measuring from. Even if the results can't be guaranteed it should be better for doctors to be aware that your trend is rising as soon as possible. If your result was 0.05 at one of my local hospitals they wouldn't know, yet the next result could be 0.07 and you'd not know if it had risen a lot or just a bit.

It seems to me that all hospitals should have equipment that detects to at least 0.01 and I wonder why hospitals have bought equipment of such low sensitivity.

Although I can guess that with my 2 hospitals that the one that mainly diagnoses would not have a big call for low readings but the one that does the surgery and follow up should have better than 0.05.

At the moment my psa is <0.05 but I'd really like to know if it is less than 0.01, but might be worried if it was more. So am in two minds.

User

Posted 18 May 2017 at 00:39

I think you have the wrong end of the stick a bit, to be honest and no-one would be given salvage treatment for being at 0.02 - if you have seen someone in that situation the decision must have been based on the outcome of their pathology and other factors like high Gleason.

The NHS and NICE define biochemical recurrence after RP as a PSA of 0.2 or above, and / or three successive rises over 0.1 so there is little benefit in having these tiny numbers. There has been much written about PSA anxiety at 2 or 3 decimal places and as you may have seen in previous posts of mine, the hospital in my area has just stopped offering PSA tests at anything less than 1 dp precisely because science is showing the rates smaller than that to be unreliable. You also need to factor in that if your PSA is 0.05 then you are at about the same level as a breast feeding woman and only a tiny bit higher than a woman that has just had an orgasm. PSA is not exclusively produced by the prostate and if your level rises from 0.05 to 0.07 it might be that your adrenal gland has been in overdrive preparing for your blood test, or you might just have been out cycling, or you could have just had sex. The concern would be if you went 0.05, 0.07, 0.10, 0.14 and so on.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 18 May 2017 at 13:03

Pete

I am in an odd situation.

My post operative PSA since January has gone from 0.014 to 0.015 to 0.019. I will have a blood test in June.

My Gleason score was 9 with positive margins.

The hospital has always been very clear to me that it is unlikely the operation cured me, but that it was an outside possibility.

Because of my pathology and gleason score, I was told I could have adjuvant radiotherapy. As my PSA was so low, the oncologist advised waiting.

I have been told I will need radiotherapy as the PSA is rising, but as others have said, it is not being offered on PSA alone. The very small rises tell the oncologist that in my case something is going on.

There has to be a very strict marrying up with PSA at these low levels and pathology and gleason. If I didn't have pT3b, positive margins etc, radiotherapy wouldn't even be considered at this stage.

Hope that helps.

Ulsterman

User

Posted 19 May 2017 at 10:18

Thanks for the replies, I wrote a full response but it got over complicated and no doubt over a few days it will settle.

It boils down to Ulsterman's onocologist using a very low level as part of her evidence, at my hospital that level would be undetectable. Whereas at Lyn's hospital they're setting a high threshold of 0.1 offering no indication until it reaches a level needing treatment. Yet that level of treatment (3 readings over 0.1) is flexible so should the threshold be so high?

It's a bit like whether all men of a certain age should be psa tested. A level of benefit v cost is deemed to be right but is it correct.

Thanks
Peter

User

Posted 19 May 2017 at 17:47

0.1 isn't a high threshold - it is half of the amount of PSA that would indicate a problem (0.2)!

A man with no prostate should have a PSA of less than 0.2

Edited by member 19 May 2017 at 17:48 | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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