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User

Posted 13 May 2021 at 20:57

Underwent robotic prostatectomy Aug 2019

PSA levels have been less than 0.010

Now its less than 0.25

Worried

User

Posted 13 May 2021 at 23:28

Sorry, but i'm pretty sure there isn't a "less than 0.010" or "less than 0.25" PSA measurement - never seen any test assays bottoming out at these levels.

Can you post exactly what the reported levels are?

User

Posted 14 May 2021 at 06:42

Sorry, I was in a panic when I posted.

PSA levels have been <0.010 microgram/ml after Robotic total prostatectomy (nerve sparing Gleason 7) every 3 months post surgery, Aug 2019.

Most recent test showed <0.025 microgram/ml. My urologist says its a concern, even though the levels still say '<'.

These are the values from the local NHS lab.

He is hinting that radiotherapy may be required.

I dread about incontinence. Had a tough time for several months and still have mild incontinence now.

My ED just about got better, say 70% or so and was feeling happy in the last few months.

Can you have a one off abnormal results?

Anyone else in this position?

Thank you

User

Posted 14 May 2021 at 06:52

Further to add, I never had a full body scan before surgery.

Will it have spread anywhere else?

Thankyou

User

Posted 14 May 2021 at 07:29

I must confess that I'm baffled by this. A result of "<0.025" means exactly that: that it's "less than 0.025". The machine isn't capable of measuring how much less. It could be zero or it could be 0.0249. 0.025 is the limit of the machine's measuring capability. Nobody can say that " <0.025" is an increase over "<0.01". It isn't.

Cheers,

Chris

User

Posted 14 May 2021 at 08:12

I thought the same too Chris.

Infact I wondered if the values in the lab were changed.

The urologist says is not the ase and is to be considered as an increase.

Thank you

Thala

User

Posted 14 May 2021 at 08:18

'case'

User

Posted 14 May 2021 at 09:36

<0.25 and <0.010 could be exactly the same value - they are both off the measurement range of the machine.

However, these are both wrongly reported - no machines have these limits, so you need to find out what the PSA values really are.

<0.01 is a common limit, but that assay can't measure to 3 decimal places. No measuring is done with a higher cutoff than <0.1, so the <0.25 is completely wrong.

User

Posted 14 May 2021 at 13:19

Thanks Andy and Chris.

know someone who works in lab and waiting to discuss results.

Will update

User

Posted 14 May 2021 at 13:46

Thala

Are the combination of measurement units used correct.

Thanks Chris

Edited by member 14 May 2021 at 14:29 | Reason: Not specified

User

Posted 14 May 2021 at 21:09

Hi Thala,

You don't have a comprehensive list of PSA results in your profile, and you seem to be mixing up your units and decimal places?

Post op my PSA was <0.03 micrograms per litre for quite some time. It's now risen to 0.3 µg/L (using the terminology in the test reports). For the full SP see my personal story

I have thus far received no treatment other than the original robotic snippage. If I were you I'd first of all make sure that you have your numbers straight. If the latest reading is actually 0.025 I'd say you have nothing whatsover to be concerned about, but the 5 on the end does look suspicious. If it's actually 0.25 then I'd expect your oncologist to be running some more tests, just like mine is currently doing. Note that currently my PSA readings are only reported with one decimal place.

Jim

Edited by member 15 May 2021 at 09:06 | Reason: Corrected ageing memory!

Reality is merely an illusion, albeit a very persistent one - Albert Einstein

User

Posted 14 May 2021 at 22:36

Mine has varied from <0.008 to <0.1 with 0.014 0.015 0.030 0.023 0.030 in between over 5 years.

All the recent research says you have nothing to gain by having adjuvant RT unless you were a G9 or 10 or had significant upgrading post OP.

So try and stop worrying, wait for another test in a few months and don't do anything until you have a clearly escalating PSA.

User

Posted 15 May 2021 at 01:18

Originally Posted by: Online Community Member

However, these are both wrongly reported - no machines have these limits, so you need to find out what the PSA values really are.

<0.01 is a common limit, but that assay can't measure to 3 decimal places. No measuring is done with a higher cutoff than <0.1, so the <0.25 is completely wrong.

I don't think you are quite right there Andy. It isn't about the capacity of the machines as much as the local decision of an NHS Trust or pathology / urology teams to determine their lower reporting threshold. John used to get his PSA results as <0.03 and then it changed to <0.1 - I know for a fact that the lab didn't go out and buy loads of new less sensitive equipment, they just changed policy. And if a reporting system is set to print 3dp even though the lower threshold is 2dp, it will come out on the printed results sheet as <0.010 or whatever.

If a hospital has decided that their lower threshold is 0.025, why is that any less likely than 0.02 or 0.03? They are all just lines in the sand, I think?

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

User

Posted 15 May 2021 at 01:24

Originally Posted by: Online Community Member

Sorry, I was in a panic when I posted.

PSA levels have been <0.010 microgram/ml after Robotic total prostatectomy (nerve sparing Gleason 7) every 3 months post surgery, Aug 2019.

Most recent test showed <0.025 microgram/ml. My urologist says its a concern, even though the levels still say '<'.

These are the values from the local NHS lab.

He is hinting that radiotherapy may be required.

I dread about incontinence. Had a tough time for several months and still have mild incontinence now.

My ED just about got better, say 70% or so and was feeling happy in the last few months.

Can you have a one off abnormal results?

Anyone else in this position?

Thank you

Thala, it is preposterous that you have been given cause to worry by your urologist. A result of <0.025 does not indicate that salvage treatment might be needed so as hard as this might be, try not to worry. You are well aware that your pathology means that you have a risk of recurrence but honestly could, you could spend your whole life worrying about the potential side effects of a potential treatment for a potential problem that never emerges!

My instinct is that it will turn out your hospital lab has just changed its reporting protocol.

Edited by member 15 May 2021 at 01:25 | Reason: Not specified

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

User

Posted 15 May 2021 at 01:26

PS there does also seem to be a growing view that the COVID vaccine might be causing temporary rises in PSA

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

User

Posted 15 May 2021 at 07:08

Quote:

If a hospital has decided that their lower threshold is 0.025, why is that any less likely than 0.02 or 0.03? They are all just lines in the sand, I think?

My experience supports that Lyn. I used to see the urologist privately and it was all very slick: turn up, get tested, then see the urologist. The test was 3 DP and apart from the first < 0.008 I never had a less than. Because it was creeping up (0.015 0.023 etc ) I had a second opinion with an onco at the same hospital, same process, same machine. This time the result was <0.1 but detectable! WTF!

The onco rang the boss of the lab and he confirmed it was the same machine but a new reporting policy meant they were no longer certified to issue 3DP ultra sensitive results. Apparently my result on the old standard was 0.025. To be sure the onco sent the same blood to a lab in London the result came back 0.03! (2DP?).

Onco advce with my Grade, Gleason etc was forget about it until it reached 0.1, I had two more tests that were about 0.03 and have now swapped to my GPs scheme which only reports to 0.1.. First test for a year next week!!!

So PSA reporting is not consistent at UPSA levels!

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