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PSA levels after a prostatectomy?

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User
Posted 27 Mar 2021 at 08:56

A month ago I had a prostatectomy and a blood test last week has shown a PSA level of 0.04 ug/L.


Is that good or bad? Does anybody know? I am awaiting my 6-week post-operative appointment with my urologist.

User
Posted 29 Mar 2021 at 02:58
My local hospital tests PSA to 0.1, below which is classed as ‘undetectable’.

Even the premier cancer hospital in Britain, The Royal Marsden only tests to 0.04, where the world renowned prostate cancer oncologist there told me testing to anything less than that is pointless. That was confirmed by my own surgeon and two other oncologists.

Start worrying if your PSA ever rises above 0.1! I just had another <0.1 result last week, so I’m not worried.

Cheers, John.

User
Posted 27 Mar 2021 at 13:03

I would say that is good. Is there a less than sign < in front of the number? if so it is excellent as that means it is lower than the figure you quoted, but the machine they use to test it isn't sensitive to go that low.


Most machines now only test down to 0.1 ug/L so your test must have been done on what is called a supersensitive machine. So at most hospitals you would have been classified as  <0.1 and everyone would have been very happy. Hospitals now tend to avoid supersnsitive tests as it causes too much worry in patients. 


One month after the operation there will still be a tiny bit of psa left over from before the operation. So your next psa test I presume in 3 months will give you a better idea. 


Some other cells in your body produce psa, so even women, who have no prostate do have a tiny amount of psa. I suspect at your post op appointment they will say they have no concerns at all if it is less than 0.1 and even if it goes above that it will only be of concern if there is a consistent trend of it rising over two or more tests. 


So in short it is good, possibly excellent, and undoubtly not bad. 


 

Dave

User
Posted 27 Mar 2021 at 15:17
Excellent news - congratulations

Re testing, I think all the labs can test to more or less the same precision; it is just that some labs have decided not to report the result as anything more precise than 1 decimal place. So the lab we use used to report to 3 decimal places and then changed their policy to 1 dp but I assume they still have the same equipment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 28 Mar 2021 at 10:48

Our GP system doesn't show the less than, <,  sign which can be confusing if you see it. 


Our nearest hospital tests down to 0.06, the one I use tests down to 0.05.   


I read that testing down to 0.03 is the lowest sensible level to have a reasonable level of accuracy.  Although there are a lot of theories.


My first psa test was 6 weeks after the op.  3 weeks is perhaps a bit early but 0.04 is a decent score.  I'd ask if it means less than 0.04.   If it's the GP they won't know, better to stay with the hospital as long as possible in my opinion.   All the best Peter


 

User
Posted 28 Mar 2021 at 11:36

Depends on the lab and hospital, and consultant's requirements.


My local district general tests down to 0.01, which their consultants regard as good enough for prostatectomy patients. My GP uses this hospital lab too.


My treatment hospital tests down to 0.1, which the consultants (both urology and oncology) regard as not good enough for prostatectomy patients, so their PSA samples are sent off-site to another lab to get more accurate results (don't know what resolution, as I'm not in that category). My oncologist prefers I get my tests done at my local district general, because he prefers the 0.01 resolution.


Another hospital I'm involved with (but not treated at) provides two different PSA tests in their lab. Prostatectomy patients are tested down to 0.003 (the minimum available as far as I know), but other patients are tested to 0.1. A G9 prostatectomy patient I have supported was put in the wrong testing bucket, and only being tested to 0.1. When he went from <0.1 to 0.1 and the urologists/oncologists then realised he hadn't been tested on the 0.003 machine as they'd expected, this caused complications, because recommended treatment options were based on how fast it had been rising, and that data was unavailable. This caused him some considerable stress, because of the lack of certainty on the path to follow.

User
Posted 28 Mar 2021 at 22:14

That is an excellent result. 

Ido4

User
Posted 09 Apr 2021 at 12:25
It seems grossly unreasonable that the urologist has allowed you to believe your PSA is a concern. First, you had your PSA test a week earlier than recommended by NICE and second, because it is so far below the threshold (0.1 or 0.2 depending how you look at it). However, the upgrading of your staging from T2 to T3b is concerning - that is the strongest indicator that salvage treatment may be needed, not your 0.04 reading. Did they give you details of where the cancer had escaped the gland and by how much? Were there any positive margins?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 09 Apr 2021 at 16:42
In the end, it will come down to the advice of an oncologist, not your urologist. In our area, oncology won't accept a referral unless / until the post-op PSA reaches 0.2 or three successive rises above 0.1 OR the post-op pathology indicates that some cancer has been left behind. Your focal margin at least tells the oncologist where to aim his raygun!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Apr 2021 at 22:39

I love it when people fight over me 😆

User
Posted 11 Apr 2021 at 08:39

Originally Posted by: Online Community Member


Bernster


I had surgery 7 years ago and things have changed, the covid situation may also have had an effect on the norm.


My post op PSA was 0.03, I had positive margins and extraprostatic extension. My six week post op  consultantation  and summary letter said I would be referred back to the consultant if the PSA breached 0.1. When it did I came back under the umbrella of urology there was no treatment at that stage and I just had three monthly tests. At 0.2, I was referred to an oncologist and started salvage radiation therapy at around 0.27.


Just a thought, are you sure he said the threshold for RT was 0.03 and not 0.3. I have seen guys at some hospitals not get salvage RT until 0.5. 


Thanks Chris



Yes. I was told by a cancer team nurse that the threshold is 0.03 which is, presumably, why my urologist has suggested that if my level increases from the 0.04 at present, a course of RT may be necessary.

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User
Posted 27 Mar 2021 at 13:03

I would say that is good. Is there a less than sign < in front of the number? if so it is excellent as that means it is lower than the figure you quoted, but the machine they use to test it isn't sensitive to go that low.


Most machines now only test down to 0.1 ug/L so your test must have been done on what is called a supersensitive machine. So at most hospitals you would have been classified as  <0.1 and everyone would have been very happy. Hospitals now tend to avoid supersnsitive tests as it causes too much worry in patients. 


One month after the operation there will still be a tiny bit of psa left over from before the operation. So your next psa test I presume in 3 months will give you a better idea. 


Some other cells in your body produce psa, so even women, who have no prostate do have a tiny amount of psa. I suspect at your post op appointment they will say they have no concerns at all if it is less than 0.1 and even if it goes above that it will only be of concern if there is a consistent trend of it rising over two or more tests. 


So in short it is good, possibly excellent, and undoubtly not bad. 


 

Dave

User
Posted 27 Mar 2021 at 15:17
Excellent news - congratulations

Re testing, I think all the labs can test to more or less the same precision; it is just that some labs have decided not to report the result as anything more precise than 1 decimal place. So the lab we use used to report to 3 decimal places and then changed their policy to 1 dp but I assume they still have the same equipment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 28 Mar 2021 at 10:48

Our GP system doesn't show the less than, <,  sign which can be confusing if you see it. 


Our nearest hospital tests down to 0.06, the one I use tests down to 0.05.   


I read that testing down to 0.03 is the lowest sensible level to have a reasonable level of accuracy.  Although there are a lot of theories.


My first psa test was 6 weeks after the op.  3 weeks is perhaps a bit early but 0.04 is a decent score.  I'd ask if it means less than 0.04.   If it's the GP they won't know, better to stay with the hospital as long as possible in my opinion.   All the best Peter


 

User
Posted 28 Mar 2021 at 11:36

Depends on the lab and hospital, and consultant's requirements.


My local district general tests down to 0.01, which their consultants regard as good enough for prostatectomy patients. My GP uses this hospital lab too.


My treatment hospital tests down to 0.1, which the consultants (both urology and oncology) regard as not good enough for prostatectomy patients, so their PSA samples are sent off-site to another lab to get more accurate results (don't know what resolution, as I'm not in that category). My oncologist prefers I get my tests done at my local district general, because he prefers the 0.01 resolution.


Another hospital I'm involved with (but not treated at) provides two different PSA tests in their lab. Prostatectomy patients are tested down to 0.003 (the minimum available as far as I know), but other patients are tested to 0.1. A G9 prostatectomy patient I have supported was put in the wrong testing bucket, and only being tested to 0.1. When he went from <0.1 to 0.1 and the urologists/oncologists then realised he hadn't been tested on the 0.003 machine as they'd expected, this caused complications, because recommended treatment options were based on how fast it had been rising, and that data was unavailable. This caused him some considerable stress, because of the lack of certainty on the path to follow.

User
Posted 28 Mar 2021 at 22:14

That is an excellent result. 

Ido4

User
Posted 29 Mar 2021 at 02:58
My local hospital tests PSA to 0.1, below which is classed as ‘undetectable’.

Even the premier cancer hospital in Britain, The Royal Marsden only tests to 0.04, where the world renowned prostate cancer oncologist there told me testing to anything less than that is pointless. That was confirmed by my own surgeon and two other oncologists.

Start worrying if your PSA ever rises above 0.1! I just had another <0.1 result last week, so I’m not worried.

Cheers, John.

User
Posted 09 Apr 2021 at 11:52

Level of  0.04 was of concern to my Urologist (5 weeks after prostate removal, where cancer was observed to be T3b, when initially diagnosed as T2c) and said RT may be required if this rises (apparently their threshold is 0.03). Another test in 2 months and then if rising, further treatment is likely to be prescribed.


Disappointing!

Edited by member 09 Apr 2021 at 11:54  | Reason: word removal

User
Posted 09 Apr 2021 at 12:25
It seems grossly unreasonable that the urologist has allowed you to believe your PSA is a concern. First, you had your PSA test a week earlier than recommended by NICE and second, because it is so far below the threshold (0.1 or 0.2 depending how you look at it). However, the upgrading of your staging from T2 to T3b is concerning - that is the strongest indicator that salvage treatment may be needed, not your 0.04 reading. Did they give you details of where the cancer had escaped the gland and by how much? Were there any positive margins?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 09 Apr 2021 at 13:43

Originally Posted by: Online Community Member
It seems grossly unreasonable that the urologist has allowed you to believe your PSA is a concern. First, you had your PSA test a week earlier than recommended by NICE and second, because it is so far below the threshold (0.1 or 0.2 depending how you look at it). However, the upgrading of your staging from T2 to T3b is concerning - that is the strongest indicator that salvage treatment may be needed, not your 0.04 reading. Did they give you details of where the cancer had escaped the gland and by how much? Were there any positive margins?


Following the surgery, the rating was upgraded to T3b N0M0, positive focal margin right base and seminal vesicle. I understand the tumour had invaded the seminal vesicles but I'm not sure if the latter were removed.


The PSA threshold for this hospital is 0.03, I was told, and now it all depends on if the level rises and the rate of increase. I am told that I am likely to need RT depending on the next result in about 7 weeks.


Thanks for responding so soon.

User
Posted 09 Apr 2021 at 15:57
I have a friend my age 53 who had RP same time as me. His post op PSA was 0.03. That was nearly 6 yrs ago. His PSA rose steadily but remains between 0.12 and 0.14 for the last 18 months. He is totally quality of life like myself and is still below the recommended 0.2 for salvage RT. So you CAN decide to watch and wait rather than pile forward with more invasive treatment and more side-effects
User
Posted 09 Apr 2021 at 16:11

Originally Posted by: Online Community Member
I have a friend my age 53 who had RP same time as me. His post op PSA was 0.03. That was nearly 6 yrs ago. His PSA rose steadily but remains between 0.12 and 0.14 for the last 18 months. He is totally quality of life like myself and is still below the recommended 0.2 for salvage RT. So you CAN decide to watch and wait rather than pile forward with more invasive treatment and more side-effects


 


Thanks, Chris, for your views. So the choice could come down to me following the advice of my urologist who is suggesting RT therapy if it rises to 0.1, with it's associated deterioration in the quality of life, or ignore his advice in the short-term, enjoy life, as best I can and see what transpires. Not sure what the next PSA  threshold should be though.


Life's a gamble, hey?

User
Posted 09 Apr 2021 at 16:42
In the end, it will come down to the advice of an oncologist, not your urologist. In our area, oncology won't accept a referral unless / until the post-op PSA reaches 0.2 or three successive rises above 0.1 OR the post-op pathology indicates that some cancer has been left behind. Your focal margin at least tells the oncologist where to aim his raygun!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 09 Apr 2021 at 17:24
Well I’m a bit of a difficult one on this forum , but my post op psa was 1.5 , and T4 with lymph involvement, and also bladder margins. I refused any further treatment until September last year. I’m still here 6 yrs on and have lived and loved and worked throughout. Had a short spell out of work due to spine RT , but I’m back now at my school job. Just saying you can be in control of your treatment as long as you know the facts. Both PCUK and my GP talked me out of salvage RT and I’m glad they did as confirmed when I had spine RT. The specialist said it wouldn’t have made any difference for me. But my case is different to yours. But weigh things up yes ? So many people just take everything that’s thrown at them and then realise they’ve hardly enjoyed themselves the last 4 yrs , and then their PSA rises again anyway
User
Posted 10 Apr 2021 at 13:35

Originally Posted by: Online Community Member
In our area, oncology won't accept a referral unless / until the post-op PSA reaches 0.2 or three successive rises above 0.1 OR the post-op pathology indicates that some cancer has been left behind.


In Oxfordshire I was told recently that if it reaches 0.17 they would start thinking about a PSMA PET scan, but they don't tend to call "recurrence" until 0.2. So that's similar.

Edited by member 10 Apr 2021 at 13:36  | Reason: Not specified

_____


Two cannibals named Ectomy and Prost, all alone on a Desert island.


Prost was the strongest, so Prost ate Ectomy.

User
Posted 10 Apr 2021 at 20:31

My first post operative psa was 0.014.  T3B. Over the next year, it went up to 0.023.  I had to pay for a PSMA scan which showed where the cancer was.  This meant the salvage Radiotherapy could be properly targeted.  My advice is get scanned before any salvage treatment.  

User
Posted 10 Apr 2021 at 21:38
Right I will try and mediate the confusing advice you are getting.

First up Chris didn't have RT because it was unlikely to be curative (Negative scans with very high post op PC means a high risk of micromets AND he wanted to maximise quality of life)

You are not in this position your post op PSA is more than 50 X lower than Chris AND you have a positive margin so they know they left some cancer behind and where it was.

Ulsterman had an equally aggressive cancer but was lucky that a PSMA scan found it (at PSA levels normally considered un scannable) he was then able to have it effectively targeted.

You could have PSMA scan like ulsterman BUT the chances are it would not find anything at your PSA levels.

Lyn is far to dismissive of ultra sensetive PSA IMHO Ulsterman is a clear example of USPSA delivering a great result BUT she is correct it is your staging AND positive margin that are the main reasons to be considering adjuvant or salvage RT.

So what should you do? Well I think you are currently doing the right thing - waiting for another USPSA test. If it has gone down, great you can consider delaying further treatment. However if it has gone up you should probably consider RT as soon as you have recovered from surgery.
User
Posted 10 Apr 2021 at 22:05

Post operatively, I was quite a mess.  Positive margins, perineural invasion and I can't remember what else.  So, regardless of my very low post operative PSA, the oncologist was already deeply suspicious that I would need further treatment.  The rising psa merely confirmed her suspicions.


Don't rush.  My oncologist urged caution and waited a year before we organised the psma scan.


And, in my opinion, doing salvage radiotherapy without a psma scan would be wrong.  I was lucky that mine found something.


And, if SRT is to happen, ask to go on HT as well.


Finally, my good news is that 2.5 years post SRT, my PSA is <0.006.

User
Posted 10 Apr 2021 at 22:25
"Lyn is far to dismissive of ultra sensetive PSA IMHO Ulsterman is a clear example of USPSA delivering a great result"

You miss the point Franci. Ulsterman didn't get salvage RT because he had a post op PSA greater than 0.000001 - he had salvage treatment because he had poor pathology and managed against all the odds to get a scan that spotted cancer in the lymph nodes.

Bernster's urologist should be up front about it - if he is considering referring Bernster to an oncologist for salvage RT, that's because of the poor pathology and positive margin, not because of his PSA.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Apr 2021 at 22:39

I love it when people fight over me 😆

User
Posted 10 Apr 2021 at 23:18

Sorry to disappoint ulsterman I would never pick a fight with Lyn - I don't like loseing


Ulsterman / Lyn I remember our discussions at the time all those years ago as at the same time my USPSA was the same as Ulsterman's (0.014 I think) my point is USPSA is useful in avoiding salvage RT with some degree of confidence. Otherwise without it a T3B with positive margin post op will normally result in a recommendation for ajuvant RT as you say Lyn.


It's just I read this thread and thought OMG this new member has had three different recommendations - all of which were right in their own context but sone of which may be very wrong in this context especially if the desired outcome is a 100% remission at any cost..


The perfect result post RP is a "less than" in whatever test you use, it's just that a less than with the UPSA is "more perfect!". Even Lyn can't argue with that, can she?

Edited by member 11 Apr 2021 at 06:32  | Reason: Not specified

User
Posted 11 Apr 2021 at 00:38
No and I wouldn't want to argue with anyone on here and I am always conscious of the impact our different opinions can have on a person who has just been given carp news. It just really upsets me to think that a medical professional can make such a careless comment with no thought to the possibly unnecessary distress that can cause. The first PSA shouldn't have been done at 5 weeks so the result is a tad unreliable anyway; it could drop rather than rise and then there will have been all this angst for no good reason. It just makes me sad.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 11 Apr 2021 at 07:46

My apologies for causing unrest in the camp. Although I have found the divergence of views confusing, I am grateful to all those that have taken time to respond.


I have reported exactly what has been said to me by my urologist, and not added any opinion of my own. Also being relatively new to this platform, I wish there was a glossary of abbreviations which are commonly used here, to aid my comprehension (although, slowly, I am getting into the lingo)!


I think, like my urologist, I have to wait and see what the PSA results are in about 6 weeks. I welcome any future contributions people may have to my situation.

User
Posted 11 Apr 2021 at 08:31

Bernster


I had surgery 7 years ago and things have changed, the covid situation may also have had an effect on the norm.


My post op PSA was 0.03, I had positive margins and extraprostatic extension. My six week post op  consultantation  and summary letter said I would be referred back to the consultant if the PSA breached 0.1. When it did I came back under the umbrella of urology there was no treatment at that stage and I just had three monthly tests. At 0.2, I was referred to an oncologist and started salvage radiation therapy at around 0.27.


Just a thought, are you sure he said the threshold for RT was 0.03 and not 0.3. I have seen guys at some hospitals not get salvage RT until 0.5. 


Thanks Chris

User
Posted 11 Apr 2021 at 08:39

Originally Posted by: Online Community Member


Bernster


I had surgery 7 years ago and things have changed, the covid situation may also have had an effect on the norm.


My post op PSA was 0.03, I had positive margins and extraprostatic extension. My six week post op  consultantation  and summary letter said I would be referred back to the consultant if the PSA breached 0.1. When it did I came back under the umbrella of urology there was no treatment at that stage and I just had three monthly tests. At 0.2, I was referred to an oncologist and started salvage radiation therapy at around 0.27.


Just a thought, are you sure he said the threshold for RT was 0.03 and not 0.3. I have seen guys at some hospitals not get salvage RT until 0.5. 


Thanks Chris



Yes. I was told by a cancer team nurse that the threshold is 0.03 which is, presumably, why my urologist has suggested that if my level increases from the 0.04 at present, a course of RT may be necessary.

User
Posted 11 Apr 2021 at 09:33

Originally Posted by: Online Community Member


Also being relatively new to this platform, I wish there was a glossary of abbreviations which are commonly used here, to aid my comprehension (although, slowly, I am getting into the lingo)!



 


There is a glossary of abreviatioms here 


https://prostatecanceruk.org/get-support/using-the-online-community?loggedIn=false&_gl=1*10gt452*_ga*MTcwMTM1MDE4LjE2MTgwODY3NzQ.*_ga_NWKX2S91S5*MTYxODEyODYwMC4yLjEuMTYxODEyOTU1Ny41Mg..&_ga=2.99517466.526664236.1618086774-170135018.1618086774


Go. To Community Main Menu/Help/Glossary.


Cheers


Bill


 


 


 

User
Posted 11 Apr 2021 at 10:24

Originally Posted by: Online Community Member


Originally Posted by: Online Community Member


Also being relatively new to this platform, I wish there was a glossary of abbreviations which are commonly used here, to aid my comprehension (although, slowly, I am getting into the lingo)!



 


There is a glossary of abreviatioms here 


https://prostatecanceruk.org/get-support/using-the-online-community?loggedIn=false&_gl=1*10gt452*_ga*MTcwMTM1MDE4LjE2MTgwODY3NzQ.*_ga_NWKX2S91S5*MTYxODEyODYwMC4yLjEuMTYxODEyOTU1Ny41Mg..&_ga=2.99517466.526664236.1618086774-170135018.1618086774


Go. To Community Main Menu/Help/Glossary.


Cheers


Bill


 


 


 



Sorry if I appear thick, but I can't seem to find the glossary using that link.

User
Posted 11 Apr 2021 at 10:45
Once you have clicked on the link, just scroll all the way down to the bottom of the page and the abbreviations are listed.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 11 Apr 2021 at 11:54

Originally Posted by: Online Community Member
Once you have clicked on the link, just scroll all the way down to the bottom of the page and the abbreviations are listed.


 


Many thanks, Lyn. The problem of using a PC in landscape mode!

Edited by member 15 Apr 2021 at 11:40  | Reason: Mis-spelling

 
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