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SECONDARY TREATMENT
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MIKERAPHONE posted:
I had an RP performed August 16, 2012: Gleason 3 + 4 = 7, with a positive margin; all of my post-surgery PSA test results (every 3 months) were undetectable (< 0.05), all tested by same lab.Well my last PSA test came back detectable at 0.028, tested by a different laboratory and my urologist is talking secondary treatment. From my understanding BCR is 0.2 and rising! Why would the other laboratory report a detectable PSA level when clearly 0.028 is lower than 0.05 ng/ml? Should I be concerned about this and rush into secondary treatment ? I have a retest sceduled if it comes back at lets say 0.030 which is only a slight rise should i then think about secondary treatment ? Please help !
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billh99 responded:
Different labs use different methods and different levels of detectability.

I used to get my test through my urologist who used LabCorp. I never saw the actual report, just "Undetectable" from the doctor.

The last one was through my PCP and he used Quest Diagnostics. And I got a copy of the actual lab report.

It is shows <0.02.
And has these comments "PSA values obtained with different assay methods or kits can not be used interchaneably".
Along with a statement that limit of accuracy for there test is 0.02.

Also there is a note that reagent was changed on 2/3/13 and the new lower level is 0.02 I have not idea of what is was before that from Quest.

Also this needs to be a Post-Prostatectomy PSA, which is a high sensitivity test, and it is different from the standard PSA.

I had to educate my PCP on the difference.

http://www.ncbi.nlm.nih.gov/pubmed/16921049

CONCLUSION: BCR defined as a PSA value of at least 0.4 ng/mL followed by another increase best explains the development of distant metastasis among 10 candidate definitions, after controlling for clinical variables and the use of secondary therapy. On the basis of this evidence, we propose that this definition be adopted as the standard for reporting the outcome of RP.


More details http://www.medicalnewstoday.com/releases/57270.php

John Hopkins starts at 02, but mainly looks at time to double.
http://urology.jhu.edu/newsletter/prostate_cancer829.php
 
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MIKERAPHONE replied to billh99's response:
Bill in your opinion are my numbers ok or worrisome ? If my retest ( different lab again ) comes back say around 0.030 which is a slight increase from 0.028 should i be concerned ?
 
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billh99 replied to MIKERAPHONE's response:
From my understanding that if you go to different lab that you really can't make a comparison.

And I suspect that at the same lab you could get tests day after day and see fluctuations of more from 0.028 and 0.0030.

I know nothing of you history or age, but for me I would be concerned, but not really worried until I saw 0.20. And then I would be figuring out if it was the right time or to wait to see how long it took to double or to wait for 0.4 or ?
 
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MIKERAPHONE replied to billh99's response:
Bill I understand that different labs may unveil different results . Do you think it's possible that my psa has been between 0.028 and 0.030 since my surgery 08/16/2013 anyway ? Remember the first couple of psa test ( same lab ) post surgery were <0.05 and if that is the case then my psa has been stable and not rising since those resullts are lower ?
 
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billh99 replied to MIKERAPHONE's response:
That is possible, but I really don't know.
 
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Basir U Tareen, MD responded:
Labs can vary. You should also inquire as to whether it in an ultra-sensitive PSA test or not. Different institutions use different PSA cutoffs to define BCR. HIstorically is was .4 and in some cases .2. In real life, we know on an ultra-sensitive PSA it should definitely be less than .1.

Bottom line is I would recheck it. a BCR will be obvious in that the rate will rise.


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