Temporary blip in PSA reading ??

User

Posted 20 Jun 2025 at 11:46

Hi all

5 years now since my RP and things seemed to be going well

Psa took a while to settle down to be undetecable and all seemed ok till it rose to 0.02, still a low number and classed as undetectable by some hospitals but in my mind still a rise ! - a tense wait till the next test 6 months later and it was steady at 0.02 so a bit happier - just had the next one done (5 year mark) and its back to undectectable <0.01 :-)

Firstly is this fluctation common? at the moment i dont need to worry anymore so do i just put it down to testing tolerance and/or my body still making a bit of PSA and deciding to make a bit more last year on those days ??

Im an engineer by trade so am fully aware of variables and tolerances when testing things and also the fact we are dealing in tiny numbers/amounts so i have tried over the years to be as consitant as i can be, getting tested at the same hospital on the same day of the week and at a similar time. So hopefully the times between the sample being taken and tested are as consitant as they can be.

For the time being im not going to stress but just curious as how this can happen -

PSA at 3 months 0.014

PSA at 6 months 0.012

PSA at 1 year 0.013

PSA at 1 1/2 years 0.011

PSA at 2 years <0.01

PSA at 2 1/2 years <0.01

PSA at 3 years <0.01

PSA at 3 1/2 years <0.01

PSA at 4 years 0.02

PSA at 4 1/2 years 0.02

PSA at 5 years <0.01

Thanks

Edited by member 20 Jun 2025 at 13:49 | Reason: spelling

User

Posted 20 Jun 2025 at 14:05

Philip,I would be quite happy with that set of scores. I do have my PSA done at the same hospital lab and I have my bloods taken at the same time of day just to try and eliminate some of the variables. I was an electrician and ambient temperatures were taken into consideration along with the frequency of using the machine. My PSA did fluctuate quite a lot but my cancer never went away. Stay vigilant with your tests. My 11 years of tests is at the start of my profile, my histology was pretty poor.

Thanks Chris

Edited by member 20 Jun 2025 at 14:06 | Reason: Not specified

User

Posted 20 Jun 2025 at 15:46

The article that Adrian refers to is very interesting.

It might just be worth adding a bit of context because it is possible that the figures quoted may even be a bit pessimistic if applied too generally. The reason that I say this is that all of the men included in the sample for this article fell into a "high risk" category - this meant that they were all either PT3/4 (i.e. their cancer had spread outside the prostate itself) and/or had positive margins. Fewer than 20% of them had the lowest grade of Gleason 6. This means that they would have had an above-average risk of recurrence from the start.

So it is possible that the percentages of men who go on to experience recurrence after recording any PSA value of say 0.01 or 0.02 may well be lower for the lower risk groups.

I should stress that I have no qualifications in this area, but, just on the basis of my general research as a layman, I think you can be very happy with your results so far.

Best wishes

Kevin

User

Posted 20 Jun 2025 at 18:13

Hi Kevin,

As usual you are spot on mate. The extract probably does not relate to Philip's cancer staging. I apologise for any confusion caused.

I should have just quoted the bit of the extract that is pertinent to Philips query regarding fluctuating PSA at very low levels. The bit about benign uPSA patterns occurring between 0.01 and 0.02 levels, plus assay noise and residual burnout. It seems that these miniscule PSA fluctuations can be caused by small amounts of normal prostate tissue left behind, PSA produced by other tissues, or even benign tissue at the edge of the removed prostate.

Edited by member 20 Jun 2025 at 18:17 | Reason: Typo

Show Most Thanked Posts

User

Posted 20 Jun 2025 at 14:05

Thanks Chris

Edited by member 20 Jun 2025 at 14:06 | Reason: Not specified

User

Posted 20 Jun 2025 at 14:25

Hi Philip.

My two local labs measure down to 0.02 and 0.04 respectively. I'm glad they don't measure down any less than that, it gives me less to worry about. 🙂

I imagine the lower you measure down to, the greater the chance of fluctuation, and the less chance you'll have as being classed undetectable?

Edited by member 20 Jun 2025 at 14:26 | Reason: Spelling

User

Posted 20 Jun 2025 at 14:28

i dont want it to sound like im not happy with them because i am - its just the memory of opening the app this time last year to see a rise to 0.02 is still very much with me and all the what if thoughts it generated - if can find a plausable reason for it, put a label on it and put it to bed ill be even happier :-)

User

Posted 20 Jun 2025 at 14:55

Hi Phil.

This shows what can cause fluctuations at these very low levels:

[Benign uPSA patterns occurred in the range from 0.01 to 0.02 ng/mL, sometimes persisting over several repeated PSA draws. Only half of patients with any postoperative of uPSA =0.01 eventually progressed to conventional biochemical recurrence. When the threshold was increased to any postoperative uPSA =0.02, about one-fourth of patients still did not experience cBCR. Once the threshold was increased to uPSA ≥0.03, nearly all patients (98%) eventually relapsed (Figure 1). Therefore, a threshold of 0.03 ng/mL was chosen to be the minimum and necessary level above potential benign patterns (assay noise, residual burnout) to identify eventual BCR.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4527538/#:~:text=Median%20Time%20to%20BCR%20(PSA%20%E2%89%A50.2%20ng/mL)&text=Benign%20uPSA%20patterns%20occurred%20in,burnout)%20to%20identify%20eventual%20BCR.

User

Posted 20 Jun 2025 at 15:46

The article that Adrian refers to is very interesting.

So it is possible that the percentages of men who go on to experience recurrence after recording any PSA value of say 0.01 or 0.02 may well be lower for the lower risk groups.

I should stress that I have no qualifications in this area, but, just on the basis of my general research as a layman, I think you can be very happy with your results so far.

Best wishes

Kevin

User

Posted 20 Jun 2025 at 18:13

Hi Kevin,

As usual you are spot on mate. The extract probably does not relate to Philip's cancer staging. I apologise for any confusion caused.

Edited by member 20 Jun 2025 at 18:17 | Reason: Typo

User

Posted 20 Jun 2025 at 20:19

Fascinating reference Adrian, and thanks for bringing it to our attention.

It clearly justifies my own hospital's policy of reporting anything less than 0.02 as "undetectable", fluctuations below that level having no diagnostic benefit but causing considerable anxiety to the patient.

To be fair the brief switch from <0.02 to =0.02 and back in Philip's data would have attracted attention where I am, though I suspect all it would have meant was that they didn't drop to yearly PSA tests.

I don't think you have any current cause for worry Philip.

User

Posted 23 Jun 2025 at 16:21

I've been going through something similar over the last year. My head tells me that it's poorly controlled variability near the lower limit of quantification (I used to develop bioanalytical methods for AstraZeneca in a past life), but the first time I got a "quantifiable result" it really knocked me back. Here are some numbers (RARP June 2021):

19-Jun-2025 PSA <0.03 ng/mL (GP what's going on?)
06-Mar-2025 PSA 0.04 ng/mL (Independent lab as I had doubts about GP lab)
19-Dec-2024 PSA 0.041 ng/mL (GP - now it's worse)
26-Jun-2024 PSA <0.03 ng/mL (GP repeat, was < missed in previous reporting?)
20-May-2024 PSA 0.03 ng/mL (GP)
24-Nov-2023 PSA <0.01 ng/mL (Hospital lab)
30-May-2023 PSA <0.01 ng/mL (Hospital lab)
14-Dec-2022 PSA <0.01 ng/mL (Hospital lab)
14-Jun-2022 PSA <0.01 ng/mL (Hospital lab)
23-Feb-2022 PSA <0.01 ng/mL (Hospital lab)
12-Nov-2021 PSA <0.01 ng/mL (Hospital lab)
16-Sep-2021 PSA <0.01 ng/mL (Hospital lab)

So I still can't be certain that there is/isn't something lurking in the background. Whatever the case, it's spurred me into opting for early retirement to enjoy myself before anything pops up that needs salvage RT. Does salvage RT come with ADT as well?

Upkeep

Notification

Join the online community now.