How Low is "Undetectable" PSA after Prostatectomy?

User

Posted 13 Apr 2023 at 21:11

Hi All,

I've noticed that some contributors to this site are able to report very low PSA tests after surgery (e.g. 0.001).

I'm 10 months post-surgery and have had 3 PSA tests since then. I received the results of each test via the Urologist's letter after each review, rather than a print-out of the actual results from the lab.

The first review letter said that PSA was "undetectable (less than 0.025)." I therefore assumed that the laboratory couldn't read anything below 0.025. I was content with that result.

Subsequent review letters have simply said "undetectable", without giving any numbers.

Yet I see other posts from people here who are able to report numbers significantly below 0.025.

Do different labs have differing-quality testing facilities?

Is my Urologist being vague, by saying 'undetectable' without giving figures?

I have now been advised that future PSA tests will be via the G.P., with reports sent to Urologist. Reviews by Urologist may be by telephone only.

I was diagnosed as Gleason 4+3 (=7), with Cribriform morphology, which I understand means recurrence is quite likely, hence the reason for my wish to be able to identify very small increases in PSA, when/if they occur.

Thanks for any info.

JedSee.

User

Posted 15 Apr 2023 at 07:13

Within a year of my prostatectomy, my PSA went from 0.014 to 0.015 to 0.019 to 0.023.

With 3 successive rises, my Oncologist recommended radiotherapy.

But I was pT3b and had positive margins and was Gleason 9. It was always suspected that I'd need salvage radiotherapy at some stage.

Your Oncologist looks at the psa and all the other bits of your personal data to inform their decision making.

That said, I'm glad of the ultra sensitive results I got. Were I with a different hospital which only measured to one decimal place, how long would I have waited for my salvage treatment and risked the cancer spreading?

My PSA has been <0.006 since salvage radiotherapy and hormone therapy.

User

Posted 14 Apr 2023 at 08:39

There are many manufacturers making analysis machines, which all (as far as I know) are capable of testing for different things, not just PSA. For any given test, an assay provided by the manufacturer is required, and these are available with different lower limits depending on the precision you require, but it also takes longer to do higher precision tests (and also very high PSA test values have to be diluted and retested to bring them within the max range). Some of the support groups had testing machines some years ago which were used for testing events, and GFCT could also lend them. (This is no longer the case.) IIRC, each assay could do something like 7 or 9 tests (I forget), with about 15 mins to get 0.1 resolution with the assay we were using for PSA screening tests at the time. (I might guess that larger non-portable machines in hospital labs might be able to work faster.) We did one event where we managed to have 3 machines running in parallel, and that could keep up with a couple of phlebotomists drawing blood to give results in real-time, 15 minutes after the blood draw.

The common lower limits I see at various different hospitals are: 0.1, 0.03, 0.025, 0.01, 0.003 - some of this may be the assay used, but I suspect figures like 0.025 may be the maximum time they're prepared to allow the test to run with the assay being capable of higher resolution, because a lower limit with more than one significant digit doesn't make much sense oherwise.

The hospital where I had radiotherapy (but not usually any blood tests) only measured down to 0.1. In a review of their cancer services which was done by the Christie (after my treatment), they were told this wasn't good enough, and they now send PSA tests to another hospital and get results to 0.01. My own district general hospital (which only does diagnosis and post-treatment monitoring, but not any treatments other than chemo and immunotherapy), has measured down to 0.01 all through my treatment, and my consultant at my treatment hospital advised me to get blood tests done at my DGH for this reason.

The higher resolutions are more important for prostatectomy patients, but that includes salvage radiotherapy patients. Some main centres now use the rise well before 0.1 (combined with other data such as histology) to act before 0.1 of followup treatments.

I'd also seen comments here about accuracy of readings below 0.1. Certainly with mine, there appears to be no noise in those readings given to an accuracy of 0.01, such that although they're reported to a resolution of 0.01, I suspect they may be measured more accurately than that, because they are all completely consistent.

Last year's Tackle conference had a talk on a new portable PSA testing machine. They way they seem to be certified is by cross-checking the results of samples in lots of different ranges against about 20 other test machine models and assays. There is a bit of variation between machines/assays, so it's good to always have your tests done by the same lab to remove this noise, but any one model of machine and assay seems to be very consistent.

Edited by member 14 Apr 2023 at 08:52 | Reason: Not specified

User

Posted 13 Apr 2023 at 23:07

Hospitals / path labs all have almost the same technology but different NHS trusts have different policies in terms of what they are willing to report on. Some have a lower reporting threshold of 0.001 or 0.025 or 0.04 - others have a lower threshold of 0.1

Undetectable just means the reading was lower than their lowest threshold. About 5-6 years ago, ultrasensitive PSA was rather discredited in a large European study - too many men were being referred for unnecessary salvage treatment and tiny rises cause significant distress, often unwarranted. At that point, many hospitals/ urologists stopped doing any PSA reporting at lower than 0.1

For John's first few years, his readings were to 3 decimal points but this has been stopped - since the EU research was published, all his results are to 0.1; even if he has his PSA test at the private hospital, he still gets a <0.1 result because the private hospital uses the NHS lab for processing. The NHS lab has not got rid of all its ultrasensitive machines; it just has a policy of not reporting the u.s. result.

In your case, I suppose the question has to be directed to your urologist - if you had a small rise from 0.025 to 0.03 would they do anything or would you still need to wait for three successive rises above 0.1? If you would not be referred to oncology until you have 3 rises over 0.1, usPSA is only going to cause you angst with no obvious benefit 🤷‍♀️

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

User

Posted 13 Apr 2023 at 23:38

Jedsee, undetectable is probably the most mis used and misunderstood word in prostate cancer terms.

At some hospitals my post op PSA levels would have been reported as "undetectable" for over two years, yet in reality my PSA was creeping up from 0.03 to 0.1. Fortunately my hospital tests to two decimal points so it didn't come as a surprise that my cancer had not been eradicated and was still growing. There must be alot of guys who suddenly get told you have a problem after months or years of being told their PSA is undetectable.

If a PSA level of say 0.06 is found by a machine how can it be "undetectable". Personally I want to know the truth , I can deal with knowing my cancer is still growing, perhaps other guys cannot.

Thanks Chris

User

Posted 14 Apr 2023 at 08:19

Thanks Chris,

Many thanks for your input.

Yes, such variations in reporting practice of PSA results do indeed seem to make the term 'undetectable' extremely misleading. Like you, I would rather know the exact measurement of PSA, even at the risk of needless worry. I'd rather have time to mentally process what I might be facing in terms of further treatment, than to be presented with a so-called 'sudden' rise in PSA, which apparently came ' out of the blue', when it was entirely predictable.

Thanks again.

JedSee.

User

Posted 14 Apr 2023 at 10:15

Just had my latest PSA result, < 0.01, so, as my GP has said, "undetectable". However I still have a prostate following Brachytherapy ( although its probably a bit battered ) so "0.01" is really just saying it's low, suits me anyway. :-) John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2

Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23 <0.01

User

Posted 14 Apr 2023 at 11:00

Hi Jedsee,

My husband is tested at a lab that tests to 0.025 aswell. He was less than that (so undetectable) for over 12 months post op. It then rose to 0.029 and six weeks later 0.044, I’m having his test done at the 6 week point again but wish I knew the actual numbers of the first 12 months as I could monitor better how quickly it has been rising. We have appointments with urologists in may so should start to have a plan then.

User

Posted 15 Apr 2023 at 19:23

Ask your doctor for a copy of the blood report. Depending on lab kit available you’ll get varying resolutions and sensitivity. Be aware at low levels ~0.006 these can move around a bit due to calibration/noise/error so don’t be alarmed so long as three sets of bloods don’t come back and show an continued increase. Even then anything <0.1 is a good result. For me I won’t started twitching <0.03 and for three year thankfully I’ve been usually <0.006.

I told my GP front of house staff I would like a copy of the blood report for my records as I’m dealing with different parties so easier to ensure there is one central repository for all the data. Works well 🙂

Bit of a learning and mindset curve this stuff 😵‍💫🤪

Edited by member 15 Apr 2023 at 19:29 | Reason: Not specified

User

Posted 15 Apr 2023 at 21:59

Hi Jedsee,

It can be confusing and there are thresholds that you might not think appropriate. Your 0.025 seems good. There seem to be factors that cause variations too. Such as using different hospitals. Also GPs tend not to use the < sign which can be worrying. I can understand you wanting early intervention.

My hospital measures to <0.05. On the 5th anniversary my reading went to 0.06 then 0.09. Both readings seemed to be a fast rise.

However it then went 0.07, 0.08, 0.1. The hospital is saying the rise is slow and it will need a faster rise or 0.2 before I'm referred to Oncology. There's always an optimistic 'if it rises' in all this.

Up to 0.1 knowing other hospitals only report at that level and the slowness of my rise I've been fairly relaxed. Also presumably other hospitals have no back history so the 3 consecutive rises are likely to be starting at 0.1 or even above if that's the first detectable reading.

Also I want a psma scan and might initiate that privately near 0.2 which is quite low for a scan anyway. The hospital won't do one below 0.5.

Chris, who wrote above, showed a report that suggested treatment is better if it starts below 0.25 if you have up to one risk factor. I think that a useful thought.

I notice you're a t3a which might warrant a close watch if it was to rise. I'm Gleason 4+4 which I believe also warrants close watching. Although it seems to me the slow increase is behaving like a lesser grade. I tell myself.

I think the threshold should be 0.05 at least to show some history. I don't like my hospitals referral levels either. We'll see how it goes though. Your 0.025 is an odd one to choose but I once read that results can be erratic below 0.03 but note Andy's confidence in consistency at low levels. Let's hope yours remains good. Regards Peter

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User

Posted 13 Apr 2023 at 23:07

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

User

Posted 13 Apr 2023 at 23:38

Jedsee, undetectable is probably the most mis used and misunderstood word in prostate cancer terms.

If a PSA level of say 0.06 is found by a machine how can it be "undetectable". Personally I want to know the truth , I can deal with knowing my cancer is still growing, perhaps other guys cannot.

Thanks Chris

User

Posted 14 Apr 2023 at 08:09

Hi LynEyre,

Many thanks for your very full reply. Everything you say makes complete sense, and your own personal experience with your husband John's test results puts it all in context.

Much appreciated.

JedSee.

User

Posted 14 Apr 2023 at 08:19

Thanks Chris,

Many thanks for your input.

Thanks again.

JedSee.

User

Posted 14 Apr 2023 at 08:39

Edited by member 14 Apr 2023 at 08:52 | Reason: Not specified

User

Posted 14 Apr 2023 at 10:15

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2

Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23 <0.01

User

Posted 14 Apr 2023 at 11:00

Hi Jedsee,

User

Posted 14 Apr 2023 at 17:58

Thanks Andy62, for your comprehensive reply.

It certainly makes me want to ensure that the path. lab, the Urologist and I all understand the same thing by the test results.

Thanks again.

JedSee.

User

Posted 14 Apr 2023 at 18:04

Thanks Elaine 4878.

These number games are certainly a challenge.

I hope everything goes well for your husband and that you get some answers at the May appointment.

Best wishes,

JedSee.

User

Posted 14 Apr 2023 at 18:06

Thanks Sparrow.

Your numbers are great! Long may they continue. 😀

Best wishes,

JedSee.

User

Posted 15 Apr 2023 at 07:13

Within a year of my prostatectomy, my PSA went from 0.014 to 0.015 to 0.019 to 0.023.

With 3 successive rises, my Oncologist recommended radiotherapy.

But I was pT3b and had positive margins and was Gleason 9. It was always suspected that I'd need salvage radiotherapy at some stage.

Your Oncologist looks at the psa and all the other bits of your personal data to inform their decision making.

My PSA has been <0.006 since salvage radiotherapy and hormone therapy.

User

Posted 15 Apr 2023 at 19:09

Thanks Ulsterman,

You make the point very well about how important miniscule differences in PSA levels can make a huge difference to treatment plans and outcomes.

Long may you continue to have such very low scores.

Best wishes,

JedSee.

User

Posted 15 Apr 2023 at 19:23

Bit of a learning and mindset curve this stuff 😵‍💫🤪

Edited by member 15 Apr 2023 at 19:29 | Reason: Not specified

User

Posted 15 Apr 2023 at 19:33

Thanks TechGuy

That's good advice. And yes, it certainly is a steep learning curve 😀.

Thanks again.

JedSee.

User

Posted 15 Apr 2023 at 20:23

If you have a successful RP with clear cancer free margins is it possible that a healthy cancer free bit of the prostate could have been left - say attached to a bit of nerve or some other bit of you and this would still produce a small amount of PSA - thus giving you a PSA reading of greater than 0.01 ?
If so , I’m guessing as long as it stays stable then it’s all good ?
or is the operation carried out in such a way that it’s all completely gone ?
This all hypothetically as mine is less than 0.01 (and long may it stay that way)

User

Posted 15 Apr 2023 at 21:59

Hi Jedsee,

My hospital measures to <0.05. On the 5th anniversary my reading went to 0.06 then 0.09. Both readings seemed to be a fast rise.

Also I want a psma scan and might initiate that privately near 0.2 which is quite low for a scan anyway. The hospital won't do one below 0.5.

Chris, who wrote above, showed a report that suggested treatment is better if it starts below 0.25 if you have up to one risk factor. I think that a useful thought.

User

Posted 15 Apr 2023 at 22:26

Originally Posted by: Online Community Member

Yes, and tiny amounts of PSA are also produced elsewhere in the body - women can produce PSA of up to 0.04 in certain circumstances and breast milk also contains PSA! This is the reason that so many labs now do not give results to less than 1dp. John's PSA has wavered between <0.1 and 0.11 for about 8 years now - as it never goes above 0.11 the oncologist has come to the view that he just produces a lot of non-cancer related PSA.

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

User

Posted 16 Apr 2023 at 19:37

Thanks Peter2016,

Yes, I certainly want to keep a close eye on my PSA levels. I just hope that I'm able to do so, given the variation in reporting! 😀.

Hope your own test results remain stable.

Best wishes,

JedSee.

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