Retzius-Sparing Laparoscopic Radical Prostatectomy

The retrospective study in the link is already 4 years old and was looking at the PSA scores of men that had the operation between 1993 and 2008. I think science has moved on since 2014 and interestingly, their conclusion seemed to be the opposite of what you are saying? In their report, men with detectable but stable PSA did just as well as those who stayed undetectable. Whether that is <0.1, <0.03 or <0.001 seems irrelevant to their findings. The researchers concluded that it was the unstable PSA with two succesive rises and / or a velocity of 0.05 or more that indicated risk which is not so far from the NICE threshold of 0.2 or three successive rises >0.1 since two successive rises of 0.05 brings the man over the 0.1 point anyway. 

That was what happened in J’s case, as it happens. The post-op PSA was something like 0.04 and dropped to 0.033 before rising to 0.068 and then 0.086 and 0.16 I think. Having the usPSA didn’t make any difference to the timing of the salvage RT; if he had been getting the results to 1dp he still would have been referred at the point when it reached 0.16 :-/

I guess usPSA is useful for men who like the extra worry; but it must be acknowledged that machine noise / tolerance range means that tiny fluctuations are not a cause for panic. It is the trend over a year or more that matters.

Edited by member 29 Jul 2018 at 01:21  | Reason: Not specified

MODERATORS - Something weird is going on. Part of Bollinge’s post has disappeared (his results of <0.1 and the biochemist and GP‘s explanations were there and now they are gone) and the middle section of my most recent post disappeared after posting. Gremlins? 

Where can I get UPSA blood tests done round here (Coventry/Brum)?

Cheers, John

Keep mentioning it - it is an interesting discussion - but it would be better if you could be factual rather than evangelical. The point is that the science is now clearly demonstrating that it is unreliable so some men have been caused undue distress and may have had unnecessary salvage or adjuvant treatment based on flawed results. It isn't the case that some hospitals are behind the times and not providing usPSA; in fact, what we are seeing is cancer centres of excellence withdrawing from usPSA testing. What concerns me more is that people read comments on sites like this, believe that their 0.05 result is a cause for concern rather than celebration and then become angry / frustrated when their urologist / oncologist explains they are undetectable and do not need further intervention. 

It is the same with LRP - there was a ground-swell of opinion that it was somehow going to be the gold standard for prostatectomy. Data has now shown that the outcomes are slightly worse than with open RP but slightly cheaper for the hospitals that already have the machinery in place and have already invested large sums of money in ensuring surgeons are trained to use it. The data is clear enough that hospitals who do not have the Da Vinci will not be investing in it in the future but still we have the evangelists who wish to ignore the facts and continue to tell everyone that LRP is 'best'. It isn't ... it is just more cost effective for the NHS and convenient for men who don't like the idea of being in hospital for a few extra days.

Selecting lab equipment can't be that straightforward.  There are people such as Ulsterman who had early treatment after a sensitive PSA test.  Those hospitals buying equipment that only measures to 0.1 would be less capable of helping him.  Also you don't know what new thinking might emerge so you'd think hospitals would play safe and buy equipment that measures a lot lower, although I'd think it costs a lot more.  I'm happy with the 0.05 at Preston and was initially happy with 0.06 at Blackpool.  I was told by one doctor that testing to lower is better.

I've read things about velocity and time of first rise and to me they're reasons to want a lower PSA reading. Although I guess it would be possible to put up with not knowing as nothing will be done for most cases, and might actually be better not to know.  So I'm not full on with this but haven't been convinced 0.1 is good enough.

On LRP, I was offered Robotic and wanted it but it was at a more distant hospital, Blackburn, and thought the possible difference in outcome was insufficient.   The thought of being in hospital an extra 6 days for an open operation is very unattractive and there is more risk, especially to older men.  I was up and ready to go the day after the op and found it a total nightmare being in hospital for the 24hrs I was feeling alright.

I was happy with my ‘undetectable’ reading, and long may they continue - I’m not holding my breath! But it would be nice to know the ‘true” reading, so as to observe any increase, if it is not a too great a demand on the NHS.

I’m not a fan of hospitals, least of all Wal’s Grave, the Super-Hospital in Coventry, where there a lot of sick people (and the clue is in the name) Auld Codger, but I hope to get referred simultaneously back there and to Warwick as well, so I can have a second opinion right away. They say the optimum time for an encounter with a ray-gun is seven months after surgery.

I noted your ‘tish’ comment, Matron, and although I consider myself fluent in English I had to look it up - it means something to do with a Jewish repast on the Sabbath! Fortunately the on-line dictionary I used also had an anagram facility which lead me to your true meaning. I also cracked Codger’s cryptic clue about cutting off my nose to spite my face. Perhaps I ought to start doing the Telegraph crossword, so as to understand future posts here.

Open surgery? For me it’s an open and shut no-no where there are minimally invasive alternatives.

Cheers, John

Edited by member 29 Jul 2018 at 18:53  | Reason: Not specified

Unfortunately 6 months ago I went in for the result and the consultant said "Less than 0.1 but detectable". Well I needless to say I was pretty p****d and so it turned out was he! He immediately went and saw the lab person and was able to wring a score out of him of 0.026 but was told they could no longer quote numbers below 0.1 because they were no longer certified even though the machines etc had not changed! To be certain the doc sent the same blood to a clinic in London and it came back 0.03 - arrgggh the same value I had just read was being considered as a candidate for biochemical recurrence!!! So six months later and back at New Cross where they still test to 0.001 I get a value of 0.023.

So Lynn is correct I should probably have taken the 0.1 route from day 1 with a G3+3 T3A that was very focal and had "just skimmed" the capsule. This would have saved me all this PSA anxiety BUT you know what I am glad I do USPSA because knowledge is power - you just have to remember it's probably only he 2nd decimal place you can rely on!!

For higher Gleaston and even more extensive spread after RP I think USPSA is essential especially if you are hoping to avoid the "ray gun"

Whoops you did say I could keep talking about it!!

Then in 2015, dad had one sample split and tested twice at the same lab; the results were 0.30 and 0.32 which the uro said was a perfect example of machine noise / tolerance.

What can we do, faced with that kind of imprecision?

/ WTF /?

Well as you might expect I am happy to disagree with the professor on the value of super sensitive testing especially in your case.
A supersensitive test now will provide you with a significant baseline and could mean further treatment is unnecessary.

So let's say you have the super sensitive test and it comes back as less than 0.001. That would be a pretty significant indication that your RP got everything including the lymph spread. This is backed up by clinical research that says anything less than 0.003 can be pretty certain there is full remission:
https://www.hopkinsmedicine.org/brady-urology-institute/specialties/conditions-and-treatments/prostate-cancer/prostate-cancer-questions/psa-how-low-should-it-go

Even if it comes back as 0.02 or something else less than 0.1 and you take the option of ajuvant RT how will you know in 18 months time if the RT has had any impact? Without a super sensitive test you will be in the dark.

Now being in the dark may be your preference but as you have found previously being in the dark is only beneficial until someone or something turns the light on!!

Edited by moderator 12 Jul 2023 at 09:29  | Reason: Not specified