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OK.. I know I felt better after the first post op psa when it was non detectable.. now the 2nd one is due and don't really know what to expect as far as odds of it going up on the second but not the first.
My rational side says it should be the same.. that if it hadn't shown up outside the prostate before surgery, after in the biopsy of the margins or nodes and then the <.004 in the follow up.
I just can't find info on these percentages..perhaps I should relax??
Hello esp:
I understand your thinking. However, my experience is that post surgical psa rarely - if ever - stays the same, especially on the ultrasensitive level. Mine has meandered between <0.003 and 0.012 for just over 4 years. I would like to suggest that you just not worry about it, but I find not worrying is next to impossible.
Here are summaries of two papers I have found helpful. If you want to read the entire paper and cannot find it with an internet search, let me know and I will E-mail a .pdf file to you.
Detection of Prostate Cancer Relapse With Prostate Specific Antigen Monitoring at Levels of 0.001 to 0.1 ug/L Yu, He; Diamandis, Eleftherios P.; Wong, Pui-Yuen; Nam, Robert; Trachtenberg, John; The Journal of Urology, Vol 157(3), March 1997, pp 913-918. Key findings:
“Monitoring postoperative cases with a highly sensitive PSA assay (detection limit 0.001 micro g./l.) could offer a simple and effective means of detecting clinically important biochemical relapse early after radical prostatectomy.”
“Our data suggest that approximately 35% of prostate cancer patients who underwent radical prostatectomy and disease is believed to be in remission based on PSA values of less than 0.1 micro g./l. have biochemical relapse as determined by an ultrasensitive PSA assay with a detection limit of 0.001 microg./l. Many of these patients could be identified by serial PSA measurements, even when the increase in serum PSA remained exclusively less than 0.08 micro g./l.”
“…it has been demonstrated that prostate cancer relapse could be identified approximately 1 year earlier in most patients with recurrence if a PSA assay with a detection limit of 0.1 instead of 0.4 [5] or 0.01 instead of 0.1 [7] micro g./l. is used for monitoring. Early identification of prostate cancer relapse is believed to be crucial for successfully treating patients with recurrent or metastatic disease.”
“…biochemical relapse was defined arbitrarily by 1 of
several criteria, including 2 or more consecutive increases in serum PSA that resulted in at least the doubling of initial PSA,any increase that resulted in serum PSA greater than 0.1 Micro g./l. or a 10-fold increase in serum PSA between 2 serum collections..”
Undetectable ultrasensitive PSA after radical
prostatectomy for prostate cancer predicts relapse-free
Survival
AP Doherty1, M Bower2, GL Smith1, R Miano1, EM Mannion3, H Mitchell4 and TJ Christmas1
British Journal of Cancer (2000) 83(11), 1432–1436. Key findings and observations:
“Thus, sensitive prostate-specific antigen assays offer accurate prognostic information and expedite decision-making regarding the use of salvage prostate-bed radiotherapy or hormone therapy.”
Undetectable considered to be < or = 0.01.
Biochemical Relapse defined as 3 successive PSA increases .
Early diagnosis of biochemical relapse is feasible with sensitive prostate-specific antigen assays.
PSA nadir measured with a sensitive assay offers the possibility of confidently predicting the removal of all significant PSA producing tissue within a few weeks of the operation. In contrast, histological evidence of relapse is usually not attained with more than 60% accuracy until the PSA rises above 2 ng ml–1 (Connolly et al, 1996) which may not occur for many years after RRP. Thus, the earliest indicator of prostate cancer relapse after radical prostatectomy is a rising PSA. Most contemporary published series use a PSA level > 0.2 ng ml–1 in defining undetectable levels of PSA (Partin et al, 1999), but levels ranging from 0.1–4 ng ml–1 have also been used (Frazier et al, 1993; Dillioglugil et al, 1995; Feneley et al, 1996; Scardino, 1998). The advent and availability of a sensitive PSA assay (Yu and Diamandis, 1993) raises questions regarding the appropriateness of these unvalidated levels.
Postoperative PSA readings are regarded by many to be the best criteria for determining tumour-free status. However, levels less than 0.2 ng ml–1 are generally considered of little clinical value,despite some large clinical studies demonstrating early detection
of relapse with sensitive PSA assays (Yu et al, 1997). Indeed, the most common level below which PSA is considered ‘undetectable is 0.2 ng mL–1. In a recent study of the natural history of PSA elevation following RRP, 23% of patients with ‘undetectable’ PSA (defined as less than 0.2 ng ml–1) biochemically relapsed
Some of my thinking about this question has previously been posted here: MY EVOLVING THINKING ON ULTRASENSITIVE PSA TESTING
2 year and 5 year anniversaries I have read are the ones where relapses tend to show up most often - although about half of the time prompt remedial radiation to the prostate bed can get rid of the responsible escaped cancer cells. I think these stats are correct. First year relapses are the most important/serious according to my urologist. All PSA related appointments are not fun occasions.
